MEDICARE: MRS. LAURA MARIE GOEHNER CF-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
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1881830339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA MARIE GOEHNER CF-SLP

Provider Business Mailing Address
First Line	:	14 HEREFORD ST APT 3
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-1605
Country	:	US
Telephone Number	:	360-433-7567
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 BEDFORD ST STE 203
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02420-4550
Country	:	US
Telephone Number	:	781-862-8085
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	01/05/2009

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