Healthcare Provider Details

I. General information

NPI: 1407746837
Provider Name (Legal Business Name): IWANA GOODWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 SAGE RD UNIT 5213
SPRINGDALE OH
45246-1680
US

IV. Provider business mailing address

500 MADISON AVE STE 200
TOLEDO OH
43604-1230
US

V. Phone/Fax

Practice location:
  • Phone: 513-923-0208
  • Fax:
Mailing address:
  • Phone: 567-312-8700
  • Fax: 567-312-8793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: