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General NPI Number Information
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NPI Number | 1417502311
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Entity Type | Individual
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Provider Name | VICTORIA GOODALE PA
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Gender | Female
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Dates
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Enumeration Date | 08/07/2019
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 21004 S STATES LN
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City | SHOREWOOD
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State | IL
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Zip | 60404-8188
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Country | US
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Telephone | 815-341-2190
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Fax |
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Provider Business Mailing Address
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Address Line | 21004 S STATES LN
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City | SHOREWOOD
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State | IL
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Zip | 60404-8188
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085008157
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License Number State | IL
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