Provider Demographics
NPI:1265672620
Name:GOODMAN, AMBER LYNN (MA)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LYNN
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7738 48TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-4603
Mailing Address - Country:US
Mailing Address - Phone:360-918-8280
Mailing Address - Fax:
Practice Address - Street 1:7738 48TH AVE SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-4603
Practice Address - Country:US
Practice Address - Phone:360-918-8280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60018145235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist