Healthcare Provider Details

I. General information

NPI: 1609442979
Provider Name (Legal Business Name): JAMES ALAN GODWIN CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 NEW YORK AVE
LA CRESCENTA CA
91214-2567
US

IV. Provider business mailing address

4310 NEW YORK AVE
LA CRESCENTA CA
91214-2567
US

V. Phone/Fax

Practice location:
  • Phone: 818-249-1863
  • Fax: 818-249-7876
Mailing address:
  • Phone: 818-249-1863
  • Fax: 818-249-7876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: