Provider Demographics
NPI:1740303759
Name:GOODMAN, AMY BETH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
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 1:972 OAK HILL CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:IN
Mailing Address - Zip Code:46540-9272
Mailing Address - Country:US
Mailing Address - Phone:765-491-4770
Mailing Address - Fax:574-825-0872
Practice Address - Street 1:972 OAK HILL CT
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:IN
Practice Address - Zip Code:46540-9272
Practice Address - Country:US
Practice Address - Phone:765-491-4770
Practice Address - Fax:574-825-0872
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003645A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist