Provider Demographics
NPI:1104824218
Name:GOODWIN, JAMES D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:D
Other - Last Name:GOODWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:25 N WENATCHEE AVE
Mailing Address - Street 2:#210A
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2282
Mailing Address - Country:US
Mailing Address - Phone:509-663-8744
Mailing Address - Fax:209-231-7130
Practice Address - Street 1:25 N WENATCHEE AVE
Practice Address - Street 2:#210A
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2282
Practice Address - Country:US
Practice Address - Phone:509-663-8744
Practice Address - Fax:209-231-7130
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001113103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPY00001113OtherPSYCHOLOGIST