Provider Demographics
NPI:1114297140
Name:GOODMAN, PERRI MARLENE (MACCC)
Entity Type:Individual
Prefix:MS
First Name:PERRI
Middle Name:MARLENE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MACCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30137 WALNUT CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2284
Mailing Address - Country:US
Mailing Address - Phone:248-661-6905
Mailing Address - Fax:
Practice Address - Street 1:37501 JOY RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-7538
Practice Address - Country:US
Practice Address - Phone:734-451-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI00200493235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist