MEDICARE: GABRIELA GOODWIN

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	235Z00000X	Speech-Language Pathologist	108703	TX

General Provider Information

NPI Number	:	1598134546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELA GOODWIN

Provider Business Mailing Address
First Line	:	6013 REEF POINT LN
Second Line	:	SUITE 401
City	:	FORT WORTH
State	:	TX
Zip	:	76135-2099
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6013 REEF POINT LN
Second Line	:	SUITE 401
City	:	FORT WORTH
State	:	TX
Zip	:	76135-2099
Country	:	US
Telephone Number	:	817-764-3825
Fax Number	:

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

Provider Enumeration Date	:	09/21/2015
Last Update Date	:	08/31/2016

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Directions to “ GABRIELA GOODWIN ” Practice Location

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