Provider Demographics
NPI:1598988669
Name:GOODLOE RICE, VERA
Entity Type:Individual
Prefix:MRS
First Name:VERA
Middle Name:
Last Name:GOODLOE RICE
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 1:1280 GARDEN VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-1951
Mailing Address - Country:US
Mailing Address - Phone:314-837-4676
Mailing Address - Fax:314-839-4044
Practice Address - Street 1:895 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-7051
Practice Address - Country:US
Practice Address - Phone:314-837-6336
Practice Address - Fax:314-839-4044
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities