Provider Demographics
NPI:1831352780
Name:GOODMAN, KRISTEN J (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:J
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 1:1101 FRONT ROYAL LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-5287
Mailing Address - Country:US
Mailing Address - Phone:704-564-4659
Mailing Address - Fax:
Practice Address - Street 1:111 CENTER PARK DR STE 103
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2128
Practice Address - Country:US
Practice Address - Phone:704-564-4659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist