Provider Demographics
NPI:1477288629
Name:GOODFELLOW, PAULA JENSEN (CCC-SLP, MA)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JENSEN
Last Name:GOODFELLOW
Suffix:
Gender:F
Credentials:CCC-SLP, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1849 AVENIDA MIMOSA
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-7121
Mailing Address - Country:US
Mailing Address - Phone:760-845-6678
Mailing Address - Fax:
Practice Address - Street 1:1849 AVENIDA MIMOSA
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-7121
Practice Address - Country:US
Practice Address - Phone:760-845-6678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121212122355S0801X
CA20791235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant