Provider Demographics
NPI:1477762193
Name:GOODWIN, CHANDRA. RENEE (HIS)
Entity Type:Individual
Prefix:MRS
First Name:CHANDRA.
Middle Name:RENEE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 W EDGEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-3419
Mailing Address - Country:US
Mailing Address - Phone:417-889-5353
Mailing Address - Fax:417-889-5355
Practice Address - Street 1:1927 S NATIONAL AVE
Practice Address - Street 2:STE. A
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2219
Practice Address - Country:US
Practice Address - Phone:417-889-5353
Practice Address - Fax:417-889-5355
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006017552237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist