Healthcare Provider Details

I. General information

NPI: 1821952490
Provider Name (Legal Business Name): NICOLE GOODWIN M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 NW 11TH ST
HERMISTON OR
97838-6601
US

IV. Provider business mailing address

610 NW 11TH ST
HERMISTON OR
97838-6601
US

V. Phone/Fax

Practice location:
  • Phone: 541-667-3635
  • Fax: 541-667-3642
Mailing address:
  • Phone: 541-667-3635
  • Fax: 541-667-3642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17312
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: