MEDICARE: MICHELE L GOGGINS 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	007439	GA

General Provider Information

NPI Number	:	1215208715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE L GOGGINS MA, CCC-SLP

Provider Business Mailing Address
First Line	:	709 CRESCENT CIR
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-4772
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	424 CREEKSTONE RDG
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-3740
Country	:	US
Telephone Number	:	678-462-1342
Fax Number	:	678-493-9464

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

Provider Enumeration Date	:	01/16/2012
Last Update Date	:	01/16/2012

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Directions to “ MICHELE L GOGGINS MA, CCC-SLP” Practice Location

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