Provider Demographics
NPI:1528046497
Name:GOETZ, SHEILA L (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:L
Last Name:GOETZ
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-6923
Mailing Address - Country:US
Mailing Address - Phone:303-440-0952
Mailing Address - Fax:303-440-0952
Practice Address - Street 1:825 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5932
Practice Address - Country:US
Practice Address - Phone:303-440-0952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO94681384Medicaid