Provider Demographics
NPI:1225202336
Name:GOETZ, SHANNON (AUD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:
Last Name:GOETZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MRS
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5601 LOCH RAVEN BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2905
Mailing Address - Country:US
Mailing Address - Phone:443-444-4848
Mailing Address - Fax:443-444-4847
Practice Address - Street 1:5601 LOCH RAVEN BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2905
Practice Address - Country:US
Practice Address - Phone:443-444-4848
Practice Address - Fax:443-444-4847
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01055231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist