MEDICARE: JENNIFER GOODMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1073386785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER GOODMAN

Provider Business Mailing Address
First Line	:	624 S CLARKSON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-4322
Country	:	US
Telephone Number	:	303-931-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	624 S CLARKSON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-4322
Country	:	US
Telephone Number	:	303-931-3774
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2023
Last Update Date	:	11/03/2023

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Directions to “ JENNIFER GOODMAN ” Practice Location

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