Healthcare Provider Details

I. General information

NPI: 1730588583
Provider Name (Legal Business Name): JESSICA GOODSTEIN AUDIOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 CEDAR ST SE STE 1
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

415 CEDAR ST SE STE 1
ALBUQUERQUE NM
87106-3927
US

V. Phone/Fax

Practice location:
  • Phone: 505-224-7020
  • Fax: 505-224-7023
Mailing address:
  • Phone: 505-224-7020
  • Fax: 505-224-7023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number0000720
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number002651
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number6714
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: