Provider Demographics
NPI:1851697452
Name:GOODRICH, ONA KATHRYN (LAC)
Entity Type:Individual
Prefix:
First Name:ONA
Middle Name:KATHRYN
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 4TH ST
Mailing Address - Street 2:SUITE 44
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3043
Mailing Address - Country:US
Mailing Address - Phone:707-483-2399
Mailing Address - Fax:
Practice Address - Street 1:7 4TH ST
Practice Address - Street 2:SUITE 44
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3043
Practice Address - Country:US
Practice Address - Phone:707-483-2399
Practice Address - Fax:707-774-6085
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-31
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13927171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist