MEDICARE: DR. KATHERINE E. GOETHE PHD

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	103G00000X	Clinical Neuropsychologist	22860	TX

General Provider Information

NPI Number	:	1588604615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE E. GOETHE PHD

Provider Business Mailing Address
First Line	:	4614 GREEN WILLOW WOODS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-1432
Country	:	US
Telephone Number	:	210-408-0200
Fax Number	:	210-408-0200

Provider Business Practice Location Address
First Line	:	6547 BANDERA RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1434
Country	:	US
Telephone Number	:	210-317-5852
Fax Number	:

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/21/2022

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