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General NPI Number Information
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NPI Number | 1225202336
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Entity Type | Individual
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Provider Name | SHANNON GOETZ AU.D.
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Gender | Female
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 5601 LOCH RAVEN BLVD SUITE 104
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City | BALTIMORE
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State | MD
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Zip | 21239-2905
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Country | US
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Telephone | 443-444-4848
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Fax | 443-444-4847
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Provider Business Mailing Address
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Address Line | 5601 LOCH RAVEN BLVD SUITE 104
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City | BALTIMORE
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State | MD
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Zip | 21239-2905
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Country | US
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Telephone | 443-444-4848
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Fax | 443-444-4847
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 01055
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License Number State | MD
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