Provider Demographics
NPI:1558876045
Name:GOODON, OLIVIA PEEK
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:PEEK
Last Name:GOODON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2913 MIMOSA DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72112-4728
Mailing Address - Country:US
Mailing Address - Phone:870-718-3452
Mailing Address - Fax:
Practice Address - Street 1:2913 MIMOSA DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-4728
Practice Address - Country:US
Practice Address - Phone:870-718-3452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR200364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist