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General NPI Number Information
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NPI Number | 1619440146
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Entity Type | Individual
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Provider Name | ASHLEY GOODSELL
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Gender | Female
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Dates
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Enumeration Date | 01/08/2019
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Last Update Date | 01/08/2019
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Provider Practice Location Address
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Address Line | 1000 SUNSET RIDGE RD
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City | NORTHBROOK
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State | IL
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Zip | 60062-4008
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Country | US
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Telephone | 224-326-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 421 W BELMONT AVE APT 3B
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City | CHICAGO
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State | IL
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Zip | 60657-0947
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Country | US
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Telephone | 480-369-6803
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 242.005055
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License Number State | IL
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