Healthcare Provider Details

I. General information

NPI: 1174673131
Provider Name (Legal Business Name): STEPHEN WILLIAM GOFF MA, CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2379 E VENICE AVE
VENICE FL
34292-3197
US

IV. Provider business mailing address

8800 SE SUNNYSIDE RD STE 300-N
CLACKAMAS OR
97015-5738
US

V. Phone/Fax

Practice location:
  • Phone: 941-485-6006
  • Fax:
Mailing address:
  • Phone: 503-659-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY 1450
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: