MEDICARE: MS. DIANA J 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	SA1319	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851699458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANA J GOODWIN

Provider Business Mailing Address
First Line	:	30 TENDRING CIR
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-6128
Country	:	US
Telephone Number	:	727-515-7551
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 TENDRING CIR
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-6128
Country	:	US
Telephone Number	:	727-515-7551
Fax Number	:

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

Provider Enumeration Date	:	03/05/2011
Last Update Date	:	03/05/2011

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Directions to “ MS. DIANA J GOODWIN ” Practice Location

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