Provider Demographics
NPI:1801837901
Name:GOODWIN, JULIE A (MS)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-4242
Mailing Address - Country:US
Mailing Address - Phone:479-621-8500
Mailing Address - Fax:479-621-8506
Practice Address - Street 1:9 PINE CONE DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8686
Practice Address - Country:US
Practice Address - Phone:479-621-8500
Practice Address - Fax:479-621-8506
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2019-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9416235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T525OtherBLUE CROSS