Provider Demographics
NPI:1083950299
Name:GOODWIN, WENDY (LAC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 CASE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-9197
Mailing Address - Country:US
Mailing Address - Phone:802-385-1900
Mailing Address - Fax:
Practice Address - Street 1:3129 CASE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-9197
Practice Address - Country:US
Practice Address - Phone:802-385-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTVT 091-0000173171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist