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General NPI Number Information
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NPI Number | 1902690845
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Entity Type | Individual
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Provider Name | MRS. SHAE JK GOODELL
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Gender | Female
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 2 MECHANIC ST UNIT 1-6
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City | EASTHAMPTON
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State | MA
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Zip | 01027-1562
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Country | US
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Telephone | 413-540-1234
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 882
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City | STODDARD
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State | NH
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Zip | 03464-0882
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Country | US
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Telephone | 603-831-3238
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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