Provider Demographics
NPI:1790825867
Name:GOODWIN, VICKI L (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:L
Last Name:GOODWIN
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 1:3155 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-8109
Mailing Address - Country:US
Mailing Address - Phone:520-908-8988
Mailing Address - Fax:
Practice Address - Street 1:3155 AVENUE C
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-8109
Practice Address - Country:US
Practice Address - Phone:520-908-8988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSLP-SP-LIC-7292235Z00000X
AZSLP2074235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist