Basic Information
| Provider Information | |||||||||
| NPI: | 1326629031 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GODBOLT | ||||||||
| FirstName: | JOSIAH | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A. CF-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 418 FOLLY ROAD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437663888 | ||||||||
| FaxNumber: | 8437663478 | ||||||||
| Practice Location | |||||||||
| Address1: | 418 FOLLY ROAD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437663888 | ||||||||
| FaxNumber: | 8437663478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2021 | ||||||||
| LastUpdateDate: | 04/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.