Provider Demographics
NPI:1629152244
Name:GOOD, ELAINE RACHELLE (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:RACHELLE
Last Name:GOOD
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 1:12443 E 1000TH RD
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944
Mailing Address - Country:US
Mailing Address - Phone:217-465-2775
Mailing Address - Fax:812-235-1526
Practice Address - Street 1:12443 E 1000TH RD
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944
Practice Address - Country:US
Practice Address - Phone:217-465-2775
Practice Address - Fax:812-235-1526
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist