Healthcare Provider Details

I. General information

NPI: 1891544052
Provider Name (Legal Business Name): HEATHER GOODALL AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 FLOYD CURL DR FL 6
SAN ANTONIO TX
78229-3931
US

IV. Provider business mailing address

8300 FLOYD CURL DR FL 6
SAN ANTONIO TX
78229-3931
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-9950
  • Fax: 210-450-6033
Mailing address:
  • Phone: 210-450-9950
  • Fax: 210-450-6033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number81605
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: