Provider Demographics
NPI:1417137886
Name:GOODWIN, DEBORAH LEE (LMP, MMP, NCTM)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LEE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LMP, MMP, NCTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65188
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-0007
Mailing Address - Country:US
Mailing Address - Phone:360-798-3917
Mailing Address - Fax:360-574-9934
Practice Address - Street 1:410 E 20TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3316
Practice Address - Country:US
Practice Address - Phone:360-798-3917
Practice Address - Fax:360-574-9934
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024747174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist