Provider Demographics
NPI:1558806141
Name:GOODMAN, LOREN (MA, MT-BC)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MA, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 S OWEN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3943
Mailing Address - Country:US
Mailing Address - Phone:224-628-8723
Mailing Address - Fax:
Practice Address - Street 1:516 S OWEN ST
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3943
Practice Address - Country:US
Practice Address - Phone:224-628-8723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist