Provider Demographics
NPI:1396245437
Name:GOODRICH, KATHERINE R
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:R
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:GOODRICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3803 COMPUTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6525
Mailing Address - Country:US
Mailing Address - Phone:919-791-3582
Mailing Address - Fax:919-791-3583
Practice Address - Street 1:3803 COMPUTER DR STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6525
Practice Address - Country:US
Practice Address - Phone:919-791-3582
Practice Address - Fax:919-791-3583
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1805012235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist