Provider Demographics
NPI:1114106044
Name:GOODWIN, ERIN MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MARIE
Other - Last Name:WHITEBREAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP/L
Mailing Address - Street 1:410 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4452
Mailing Address - Country:US
Mailing Address - Phone:630-930-8733
Mailing Address - Fax:
Practice Address - Street 1:410 W 8TH ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4452
Practice Address - Country:US
Practice Address - Phone:630-930-8733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-27
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009094235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist