Provider Demographics
NPI:1720579030
Name:HALL, GOLDIE PAPPAN (AUD)
Entity type:Individual
Prefix:
First Name:GOLDIE
Middle Name:PAPPAN
Last Name:HALL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:GOLDIE
Other - Middle Name:LELA
Other - Last Name:PAPPAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4200 LAKE OTIS PKWY STE 302
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5226
Mailing Address - Country:US
Mailing Address - Phone:907-561-1326
Mailing Address - Fax:
Practice Address - Street 1:4200 LAKE OTIS PKWY STE 302
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5226
Practice Address - Country:US
Practice Address - Phone:907-561-1326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X
AK134824231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1684899Medicaid