Provider Demographics
NPI:1881831824
Name:GOOD, MARTIA (MA-CCC-A)
Entity Type:Individual
Prefix:
First Name:MARTIA
Middle Name:
Last Name:GOOD
Suffix:
Gender:F
Credentials:MA-CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1843 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2115
Mailing Address - Country:US
Mailing Address - Phone:215-629-1353
Mailing Address - Fax:866-521-0299
Practice Address - Street 1:1843 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2115
Practice Address - Country:US
Practice Address - Phone:215-629-1353
Practice Address - Fax:866-521-0299
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO2-0000101231H00000X
PAAT005861231H00000X
NJ41YA00072400231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist