MEDICARE: KATHERINE POUEYMIROU GOODPASTURE MA, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	8042	NC

General Provider Information

NPI Number	:	1013289834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE POUEYMIROU GOODPASTURE MA, CCC-SLP

Provider Business Mailing Address
First Line	:	111 S TREMONT DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27403-1734
Country	:	US
Telephone Number	:	512-695-2743
Fax Number	:

Provider Business Practice Location Address
First Line	:	5603B W FRIENDLY AVE # 274
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-4213
Country	:	US
Telephone Number	:	336-790-0271
Fax Number	:	336-740-9099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2012
Last Update Date	:	04/06/2026

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Directions to “ KATHERINE POUEYMIROU GOODPASTURE MA, CCC-SLP” Practice Location

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