Healthcare Provider Details

I. General information

NPI: 1053249268
Provider Name (Legal Business Name): PAYTEN GOODMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W MATTHEWS ST
MATTHEWS NC
28105-1309
US

IV. Provider business mailing address

5311 UNIONVILLE RD
MONROE NC
28110-9441
US

V. Phone/Fax

Practice location:
  • Phone: 704-846-0262
  • Fax:
Mailing address:
  • Phone: 704-649-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30005078
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: