Provider Demographics
NPI:1336224468
Name:GOODMAN, JENNIFER C
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:C
Last Name:GOODMAN
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 1:2975 E PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-6439
Mailing Address - Country:US
Mailing Address - Phone:480-892-2716
Mailing Address - Fax:480-279-1583
Practice Address - Street 1:2975 E PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-6439
Practice Address - Country:US
Practice Address - Phone:480-892-2716
Practice Address - Fax:480-279-1583
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL4544235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist