Provider Demographics
NPI:1265240386
Name:GOODWIN, GLORIA A (SOLE PROPIETOR)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:A
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:SOLE PROPIETOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2765 SW 194TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-2844
Mailing Address - Country:US
Mailing Address - Phone:971-998-9719
Mailing Address - Fax:
Practice Address - Street 1:2765 SW 194TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97003-2844
Practice Address - Country:US
Practice Address - Phone:971-998-9719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR604139926171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter