Provider Demographics
NPI:1932282548
Name:GOODHART, ROBYN L (CFA, RSA)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:L
Last Name:GOODHART
Suffix:
Gender:F
Credentials:CFA, RSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21258 W MONTERREY DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-6467
Mailing Address - Country:US
Mailing Address - Phone:815-278-1782
Mailing Address - Fax:
Practice Address - Street 1:21258 W MONTERREY DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-6467
Practice Address - Country:US
Practice Address - Phone:815-278-1782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL84192246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist