MEDICARE: JILLIAN GOODMAN SLP-CCC

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	235Z00000X	Speech-Language Pathologist	SA18217	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407215155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN GOODMAN SLP-CCC

Provider Business Mailing Address
First Line	:	4 W LAS OLAS BLVD APT 2404
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-3091
Country	:	US
Telephone Number	:	954-599-4650
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 W LAS OLAS BLVD APT 2404
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-3091
Country	:	US
Telephone Number	:	954-599-4650
Fax Number	:

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

Provider Enumeration Date	:	02/22/2016
Last Update Date	:	05/07/2021

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Directions to “ JILLIAN GOODMAN SLP-CCC” Practice Location

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