Provider Demographics
NPI:1720274772
Name:GOODMAN, CARYN LEIGH (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARYN
Middle Name:LEIGH
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S SANGAMON ST
Mailing Address - Street 2:UNIT 706
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3196
Mailing Address - Country:US
Mailing Address - Phone:917-570-3427
Mailing Address - Fax:
Practice Address - Street 1:225 S SANGAMON ST
Practice Address - Street 2:UNIT 706
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3196
Practice Address - Country:US
Practice Address - Phone:917-570-3427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-23
Last Update Date:2007-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist