Provider Demographics
NPI:1578514568
Name:GOODALL, ARLENE L (EARLYINTERVENTIONSPE)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:L
Last Name:GOODALL
Suffix:
Gender:F
Credentials:EARLYINTERVENTIONSPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17213 KIMBARK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-3579
Mailing Address - Country:US
Mailing Address - Phone:708-710-0459
Mailing Address - Fax:708-331-8236
Practice Address - Street 1:17213 KIMBARK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-3579
Practice Address - Country:US
Practice Address - Phone:708-710-0459
Practice Address - Fax:708-331-8236
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist