=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417266438
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHEILA LOUISE GOOD CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2010
-----------------------------------------------------
Last Update Date | 09/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 JUNIPER DR
-----------------------------------------------------
City | COTATI
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94931-4322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-810-4040
-----------------------------------------------------
Fax | 707-992-0253
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 JUNIPER DR
-----------------------------------------------------
City | COTATI
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94931-4322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-810-4040
-----------------------------------------------------
Fax | 707-992-0253
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SP 16604
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------