Provider Demographics
NPI:1124795786
Name:GOETTEL, ILIANNA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ILIANNA
Middle Name:
Last Name:GOETTEL
Suffix:
Gender:
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7607 MOUNT PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-5011
Mailing Address - Country:US
Mailing Address - Phone:727-415-4083
Mailing Address - Fax:
Practice Address - Street 1:1707 VILLAGE CENTER CIR STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-0597
Practice Address - Country:US
Practice Address - Phone:702-899-5810
Practice Address - Fax:702-899-5855
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-2844235Z00000X
NVSP-3149235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty