Provider Demographics
NPI:1730588583
Name:GOODSTEIN, JESSICA (AUDIOLOGIST)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GOODSTEIN
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 CEDAR ST SE STE 1
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-3927
Mailing Address - Country:US
Mailing Address - Phone:505-224-7020
Mailing Address - Fax:505-224-7023
Practice Address - Street 1:415 CEDAR ST SE STE 1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-224-7020
Practice Address - Fax:505-224-7023
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000720237600000X
NY002651237600000X
NM6714237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter