Provider Demographics
NPI:1760017875
Name:WILLOUGHBY-GODWIN, GIDGET J
Entity Type:Individual
Prefix:
First Name:GIDGET
Middle Name:J
Last Name:WILLOUGHBY-GODWIN
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 1:2222 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-4545
Mailing Address - Country:US
Mailing Address - Phone:509-413-2950
Mailing Address - Fax:509-241-1866
Practice Address - Street 1:2222 N MONROE ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4545
Practice Address - Country:US
Practice Address - Phone:509-413-2950
Practice Address - Fax:509-241-1866
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist