Provider Demographics
NPI:1063863033
Name:ALLEN, JESSICA GOODWIN (AUD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:GOODWIN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:CHRISTINE
Other - Last Name:GOODWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:4045 JOHNS CREEK PKWY
Mailing Address - Street 2:STE B
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024
Mailing Address - Country:US
Mailing Address - Phone:770-814-1260
Mailing Address - Fax:770-814-1261
Practice Address - Street 1:4045 JOHNS CREEK PKWY STE B
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1218
Practice Address - Country:US
Practice Address - Phone:770-814-1260
Practice Address - Fax:770-814-1261
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist