=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538635156
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANN M GOODSPEED
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2018
-----------------------------------------------------
Last Update Date | 10/22/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1531 W RIVER RD N
-----------------------------------------------------
City | ELYRIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44035-2700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-324-4788
-----------------------------------------------------
Fax | 440-324-4087
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32801 GLEN DR
-----------------------------------------------------
City | NORTH RIDGEVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44039-3401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-328-6704
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 11095
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------