Provider Demographics
NPI:1053505818
Name:GOODMAN, KIMBERLY JOYCE (DT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JOYCE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8319 S HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-6025
Mailing Address - Country:US
Mailing Address - Phone:773-507-0795
Mailing Address - Fax:773-881-1753
Practice Address - Street 1:8319 S HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-6025
Practice Address - Country:US
Practice Address - Phone:773-507-0795
Practice Address - Fax:773-881-1753
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist