Healthcare Provider Details

I. General information

NPI: 1619702800
Provider Name (Legal Business Name): OUTSIDE VOICES SPEECH THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 WRIGHT AVE APT 807
MOUNTAIN VIEW CA
94043-4615
US

IV. Provider business mailing address

928 WRIGHT AVE APT 807
MOUNTAIN VIEW CA
94043-4615
US

V. Phone/Fax

Practice location:
  • Phone: 214-263-2121
  • Fax:
Mailing address:
  • Phone: 214-263-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ANDREA RAE GODDARD
Title or Position: OWNER
Credential: MA, CCC-SLP
Phone: 408-508-4193