Provider Demographics
NPI:1487824157
Name:GOODMAN, AMANDA SHEPHERD (MS SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:SHEPHERD
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-5095
Mailing Address - Country:US
Mailing Address - Phone:501-753-5459
Mailing Address - Fax:
Practice Address - Street 1:1540 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-5095
Practice Address - Country:US
Practice Address - Phone:501-753-5459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-09
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR200571235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist