Provider Demographics
NPI:1053538819
Name:GODBOLE, MANISHA (AUD)
Entity type:Individual
Prefix:DR
First Name:MANISHA
Middle Name:
Last Name:GODBOLE
Suffix:
Gender:
Credentials:AUD
Other - Prefix:
Other - First Name:MANISHA
Other - Middle Name:
Other - Last Name:KELKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3170 KETTERING BLVD BLDG B2ND
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-991-3188
Mailing Address - Fax:
Practice Address - Street 1:369 W 1ST ST
Practice Address - Street 2:SUITE 406
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-3095
Practice Address - Country:US
Practice Address - Phone:937-222-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-01433231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist