Provider Demographics
NPI:1497881551
Name:GOODMAN, TERRI JOAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:JOAN
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CURCIO CT
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-8227
Mailing Address - Country:US
Mailing Address - Phone:516-840-1612
Mailing Address - Fax:
Practice Address - Street 1:109 CURCIO CT
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-8227
Practice Address - Country:US
Practice Address - Phone:516-840-1612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002850-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist