Basic Information
| Provider Information | |||||||||
| NPI: | 1760537849 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOODRICH | ||||||||
| FirstName: | AMY | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 MAIN ST | ||||||||
| Address2: | APARTMENT 3D | ||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319093584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063246112 | ||||||||
| FaxNumber: | 7065968259 | ||||||||
| Practice Location | |||||||||
| Address1: | 705 17TH ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319013500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063246112 | ||||||||
| FaxNumber: | 7065968259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2355S0801X | SLPA000135 | GA | Y | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant |
No ID Information.