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General NPI Number Information
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NPI Number | 1740767318
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Entity Type | Individual
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Provider Name | LESLIE BROOKE GOAD
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Gender | Female
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Dates
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Enumeration Date | 07/25/2018
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Last Update Date | 07/25/2018
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Provider Practice Location Address
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Address Line | 13010 EASTGATE PARK WAY
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City | LOUISVILLE
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State | KY
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Zip | 40223-3984
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Country | US
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Telephone | 502-244-1210
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Fax |
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Provider Business Mailing Address
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Address Line | 2014 WOODBOURNE AVE
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City | LOUISVILLE
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State | KY
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Zip | 40205-1910
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Country | US
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Telephone | 270-869-7405
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Fax |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 173569
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License Number State | KY
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