Basic Information
| Provider Information | |||||||||
| NPI: | 1194062778 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOETTSCH | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | ROSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 521 PALERMO WAY | ||||||||
| Address2: | |||||||||
| City: | LA HABRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906314229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888087838 | ||||||||
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| Practice Location | |||||||||
| Address1: | 249 E OCEAN BLVD STE 440 | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908024806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888087838 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2013 | ||||||||
| LastUpdateDate: | 01/15/2013 | ||||||||
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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 | 235Z00000X | 1205 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.