Provider Demographics
NPI:1295964690
Name:GOODSON, ELAINE (RD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:GOODSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 COMAL ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-4326
Mailing Address - Country:US
Mailing Address - Phone:512-978-9200
Mailing Address - Fax:512-978-9220
Practice Address - Street 1:211 COMAL ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-4326
Practice Address - Country:US
Practice Address - Phone:512-978-9200
Practice Address - Fax:512-978-9220
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX473437133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered