Provider Demographics
NPI:1013354646
Name:GOODWIN, DENINE M
Entity Type:Individual
Prefix:
First Name:DENINE
Middle Name:M
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 GLENWOOD AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-1043
Mailing Address - Country:US
Mailing Address - Phone:919-781-9565
Mailing Address - Fax:
Practice Address - Street 1:2626 GLENWOOD AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-1043
Practice Address - Country:US
Practice Address - Phone:919-781-9565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5975235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist