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NPI Code Detail

MEDICARE: ILIANNA GOETTEL M.S. CCC-SLP

MEDICARE: ILIANNA GOETTEL M.S. CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistSP-2844NV
2235Z00000XSpeech-Language PathologistSP-3149NV

General Provider Information

NPI Number : 1124795786
Entity Type Code : Individual
Provider Name (Legal Business Name) : ILIANNA GOETTEL M.S. CCC-SLP
Provider Business Mailing Address
First Line : 7607 MOUNT PRINCETON ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89166-5011
Country : US
Telephone Number : 727-415-4083
Fax Number :
Provider Business Practice Location Address
First Line : 1707 VILLAGE CENTER CIR STE 150
Second Line :
City : LAS VEGAS
State : NV
Zip : 89134-0597
Country : US
Telephone Number : 702-899-5810
Fax Number : 702-899-5855
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2021
Last Update Date : 04/22/2025

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Directions to “ ILIANNA GOETTEL M.S. CCC-SLP” Practice Location

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