=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619702800
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OUTSIDE VOICES SPEECH THERAPY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2024
-----------------------------------------------------
Last Update Date | 09/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 928 WRIGHT AVE APT 807
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94043-4615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-263-2121
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 928 WRIGHT AVE APT 807
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94043-4615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-263-2121
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANDREA RAE GODDARD
-----------------------------------------------------
Credential | MA, CCC-SLP
-----------------------------------------------------
Telephone | 408-508-4193
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------