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Individual

LEONARD J HEDGES-GOETTL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PSY. D.

Contact information

Practice address
1088 W BALTIMORE PIKE, SUITE 2205, MEDIA, PA 19063-5146
(610) 744-2960
(610) 744-2420
Mailing address
1088 W BALTIMORE PIKE, SUITE 2205, MEDIA, PA 19063-5146
(610) 744-2960
(610) 744-2420

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
263827
WI
103T00000X
Psychologist
Primary
PS009035L
PA
103TC0700X
Clinical Psychologist
PS009035L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
39153700
WI
01
WI1451001
MEDICARE PTAN
Enumeration date
05/04/2006
Last updated
09/02/2020
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