Provider Demographics
NPI:1306510763
Name:GOEDERT, CECILIA MARIE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:MARIE
Last Name:GOEDERT
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:CECILIA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15809 BEAR CREEK PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-1542
Mailing Address - Country:US
Mailing Address - Phone:425-882-6100
Mailing Address - Fax:844-660-0701
Practice Address - Street 1:15809 BEAR CREEK PKWY STE 100
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-1542
Practice Address - Country:US
Practice Address - Phone:425-882-6100
Practice Address - Fax:844-660-0701
Is Sole Proprietor?:No
Enumeration Date:2021-08-08
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17190235Z00000X
WALL61202947235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist