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NPI Code Detail

MEDICARE: AMANDA HAGER GOODRICH AU.D.

MEDICARE: AMANDA HAGER GOODRICH AU.D.
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
1231H00000XAudiologist
2231H00000XAudiologist23002622AIN

General Provider Information

NPI Number : 1447771605
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA HAGER GOODRICH AU.D.
Provider Business Mailing Address
First Line : 2 N MERIDIAN ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46204-3021
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1200 E 42ND ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46205-2004
Country : US
Telephone Number : 317-232-7349
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2017
Last Update Date : 04/09/2019

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