Healthcare Provider Details

I. General information

NPI: 1306766308
Provider Name (Legal Business Name): KAILYNN GOODYEAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30811 LAKE LOGAN RD
LOGAN OH
43138-9546
US

IV. Provider business mailing address

570 ZANESVILLE AVE
LOGAN OH
43138-1473
US

V. Phone/Fax

Practice location:
  • Phone: 513-319-5776
  • Fax:
Mailing address:
  • Phone: 513-319-5776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: