Provider Demographics
NPI:1912542325
Name:GOODWIN, KAELA MARIE (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAELA
Middle Name:MARIE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:MISS
Other - First Name:KAELA
Other - Middle Name:MARIE
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35405 CALENDULA CIR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-8947
Mailing Address - Country:US
Mailing Address - Phone:951-502-4000
Mailing Address - Fax:
Practice Address - Street 1:41760 IVY ST STE 101
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9416
Practice Address - Country:US
Practice Address - Phone:951-595-4673
Practice Address - Fax:951-595-4301
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ9412235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist