Provider Demographics
NPI:1447771605
Name:GOODRICH, AMANDA HAGER (AUD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:HAGER
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:HAGER
Other - Last Name:GOODRICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-3021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 E 42ND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2004
Practice Address - Country:US
Practice Address - Phone:317-232-7349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X
IN23002622A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist