Provider Demographics
NPI:1801306824
Name:GODARD, CHERICE F
Entity type:Individual
Prefix:
First Name:CHERICE
Middle Name:F
Last Name:GODARD
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 1:12721 SW 108TH TER
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4299
Mailing Address - Country:US
Mailing Address - Phone:503-984-8754
Mailing Address - Fax:
Practice Address - Street 1:17440 BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5220
Practice Address - Country:US
Practice Address - Phone:503-770-4663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator