Healthcare Provider Details

I. General information

NPI: 1013915545
Provider Name (Legal Business Name): KATHY LANDAU GOODMAN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 MONTGOMERY AVE MAIN LINE AUDIOLOGY CONSULTANTS, PC
NARBERTH PA
19072
US

IV. Provider business mailing address

916 MONTGOMERY AVE MAIN LINE AUDIOLOGY CONSULTANTS, PC
NARBERTH PA
19072
US

V. Phone/Fax

Practice location:
  • Phone: 610-667-3277
  • Fax: 610-667-1662
Mailing address:
  • Phone: 610-667-3277
  • Fax: 610-667-1662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAT000310L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number41YA00031600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: