Healthcare Provider Details

I. General information

NPI: 1194176255
Provider Name (Legal Business Name): GEENA GOYETTE M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 06/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 POSA PL
DARTMOUTH MA
02747-2511
US

IV. Provider business mailing address

1 POSA PL
DARTMOUTH MA
02747-2511
US

V. Phone/Fax

Practice location:
  • Phone: 508-996-3391
  • Fax:
Mailing address:
  • Phone: 508-996-3391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number76402
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: