Provider Demographics
NPI:1083391353
Name:GOODMAN, KAILYN RENEE
Entity Type:Individual
Prefix:
First Name:KAILYN
Middle Name:RENEE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 S. MAIN STREET, LIMA, OHIO, 45804
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804
Mailing Address - Country:US
Mailing Address - Phone:419-222-1168
Mailing Address - Fax:
Practice Address - Street 1:2627 CRYSTAL AVE
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-4459
Practice Address - Country:US
Practice Address - Phone:419-222-1168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician