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NPI Code Detail

MEDICARE: MS. JESSICA ANNA GOODMAN M.ED.

MEDICARE: MS. JESSICA ANNA GOODMAN M.ED.
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1831359736
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JESSICA ANNA GOODMAN M.ED.
Provider Business Mailing Address
First Line : 29 CONGRESS ST APT 24
Second Line :
City : NASHUA
State : NH
Zip : 03062-3378
Country : US
Telephone Number : 603-759-4821
Fax Number :
Provider Business Practice Location Address
First Line : 148 WARREN ST
Second Line :
City : LOWELL
State : MA
Zip : 01852-2208
Country : US
Telephone Number : 978-452-1736
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2008
Last Update Date : 06/13/2008

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