Provider Demographics
NPI:1720138316
Name:GOODMAN, SANDRA ELIZABETH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:ELIZABETH
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14802 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-4323
Mailing Address - Country:US
Mailing Address - Phone:480-759-6437
Mailing Address - Fax:
Practice Address - Street 1:500 W GUADALUPE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3599
Practice Address - Country:US
Practice Address - Phone:480-839-0292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0861235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist