Provider Demographics
NPI:1609409515
Name:GOODMAN, MITZI WHITFIELD (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MITZI
Middle Name:WHITFIELD
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24647 NE COUNTY ROAD 69A
Mailing Address - Street 2:
Mailing Address - City:ALTHA
Mailing Address - State:FL
Mailing Address - Zip Code:32421-3473
Mailing Address - Country:US
Mailing Address - Phone:850-899-3553
Mailing Address - Fax:
Practice Address - Street 1:100 WESTSIDE DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1908
Practice Address - Country:US
Practice Address - Phone:334-793-2237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA20518235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist