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General NPI Number Information
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NPI Number | 1194943860
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Entity Type | Organization
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Legal Business Name | GOODWILL GREATER CLEVELAND AND EAST CENTRAL OHIO
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 408 NINTH STREET SW
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City | CANTON
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State | OH
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Zip | 44707-4714
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Country | US
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Telephone | 330-445-1035
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Fax | 330-454-1014
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Provider Business Mailing Address
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Address Line | 408 NINTH STREET SW
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City | CANTON
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State | OH
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Zip | 44707
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Country | US
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Telephone | 330-445-1059
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Fax | 330-454-1014
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MARK TREW
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Credential |
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Telephone | 330-445-1035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | A00436
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP2281
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP8183
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP3189
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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