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General NPI Number Information
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NPI Number | 1811228513
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Entity Type | Individual
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Provider Name | CHRISTINE ALICE GOODALL
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Gender | Female
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Dates
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Enumeration Date | 01/19/2010
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Last Update Date | 01/19/2010
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Provider Practice Location Address
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Address Line | 750 E RILEY DR
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City | AVONDALE
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State | AZ
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Zip | 85323-2004
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Country | US
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Telephone | 623-932-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 8606 N 192ND AVE
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City | WADDELL
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State | AZ
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Zip | 85355-9664
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Country | US
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Telephone | 623-694-1011
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SLPA6394
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License Number State | AZ
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