Provider Demographics
NPI:1861913014
Name:GODDARD-HYMAS, BAILEE MIKELLE (AUD)
Entity type:Individual
Prefix:DR
First Name:BAILEE
Middle Name:MIKELLE
Last Name:GODDARD-HYMAS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:BAILEE
Other - Middle Name:MIKELLE
Other - Last Name:GODDARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 30180
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130-0180
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 N MARIO CAPECCHI DR STE 1600
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-662-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13650656-4101231H00000X
TX80984231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist