Provider Demographics
NPI:1588215222
Name:GOODWIN, ANN (QMHS 3 SPECIALTY)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:QMHS 3 SPECIALTY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45439-2214
Mailing Address - Country:US
Mailing Address - Phone:937-299-9060
Mailing Address - Fax:937-299-3040
Practice Address - Street 1:3440 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45439-2214
Practice Address - Country:US
Practice Address - Phone:937-299-9060
Practice Address - Fax:937-299-3040
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician