Basic Information
| Provider Information | |||||||||
| NPI: | 1043568173 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GODOVIN | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 191 | ||||||||
| Address2: | AUDIOLOGY DEPARTMENT | ||||||||
| City: | ROCKLAND | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197320191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026516212 | ||||||||
| FaxNumber: | 3026514945 | ||||||||
| Practice Location | |||||||||
| Address1: | 3855 W CHESTER PIKE STE 280 | ||||||||
| Address2: | AUDIOLOGY DEPARTMENT | ||||||||
| City: | NEWTOWN SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190732304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105574800 | ||||||||
| FaxNumber: | 6105574816 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2012 | ||||||||
| LastUpdateDate: | 03/19/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | O2-0000193 | DE | N | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | AT006265 | PA | Y | Speech, Language and Hearing Service Providers | Audiologist | 231HA2400X | O2-0000193 | DE | N | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Practitioner | 231HA2400X | AT006265 | PA | N | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Practitioner | 231HA2500X | O2-0000193 | DE | N | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Supplier | 231HA2500X | AT006265 | PA | N | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Supplier | 237600000X | O2-0000193 | DE | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 237600000X | AT006265 | PA | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.