Provider Demographics
NPI:1295836708
Name:GOODMAN-HERRICK, PEARLYN (ND)
Entity Type:Individual
Prefix:
First Name:PEARLYN
Middle Name:
Last Name:GOODMAN-HERRICK
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 BUTTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1008
Mailing Address - Country:US
Mailing Address - Phone:415-306-7699
Mailing Address - Fax:
Practice Address - Street 1:1429 BUTTERFIELD RD
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960
Practice Address - Country:US
Practice Address - Phone:415-306-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000048175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110000048CT01OtherANTHEM