Provider Demographics
NPI:1952413536
Name:GOODWIN, SHON L (MS)
Entity Type:Individual
Prefix:
First Name:SHON
Middle Name:L
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 HANEY CT
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8664
Mailing Address - Country:US
Mailing Address - Phone:502-867-2287
Mailing Address - Fax:866-924-1957
Practice Address - Street 1:112 HANEY CT
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8664
Practice Address - Country:US
Practice Address - Phone:502-867-2287
Practice Address - Fax:866-924-1957
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0117103T00000X
KY0592103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist