MEDICARE: NATALIE GOODWIN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY60479161	WA

General Provider Information

NPI Number	:	1215464953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE GOODWIN PHD

Provider Business Mailing Address
First Line	:	1127 10TH AVE E STE 2
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-4377
Country	:	US
Telephone Number	:	425-954-6584
Fax Number	:

Provider Business Practice Location Address
First Line	:	1127 10TH AVE E STE 2
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-4377
Country	:	US
Telephone Number	:	425-954-6584
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2017
Last Update Date	:	08/16/2020

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