Provider Demographics
NPI:1225052384
Name:GOODMAN, REBECCA A (MA/CCC-L)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:A
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MA/CCC-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26W055 SIOUX COURT
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187
Mailing Address - Country:US
Mailing Address - Phone:630-776-4088
Mailing Address - Fax:
Practice Address - Street 1:26W055 SIOUX CT
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-7947
Practice Address - Country:US
Practice Address - Phone:630-776-4088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9405074OtherPHCS
ILRG78781198POtherEARLY INTERVENTION
IL2232394OtherBCBSIL
IL00079785591OtherAETNA