Provider Demographics
NPI:1427358159
Name:GOODMAN, DENA CARLY
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:CARLY
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19303 FREMONT AVE N # MS 84
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3800
Mailing Address - Country:US
Mailing Address - Phone:206-546-7400
Mailing Address - Fax:
Practice Address - Street 1:19303 FREMONT AVE N # MS 84
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3800
Practice Address - Country:US
Practice Address - Phone:206-546-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI 60186078235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist