MEDICARE: MRS. MARY CARTER GOODMAN M.S. CCC-SLP

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	2202003985	VA

General Provider Information

NPI Number	:	1902110786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY CARTER GOODMAN M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	1649 RIVER RD W
Second Line	:
City	:	CROZIER
State	:	VA
Zip	:	23039-2511
Country	:	US
Telephone Number	:	804-337-6337
Fax Number	:

Provider Business Practice Location Address
First Line	:	4102 E PARHAM RD
Second Line	:	SUITE A
City	:	RICHMOND
State	:	VA
Zip	:	23228-2743
Country	:	US
Telephone Number	:	804-672-8588
Fax Number	:	804-672-8587

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

Provider Enumeration Date	:	08/04/2010
Last Update Date	:	08/04/2010

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Directions to “ MRS. MARY CARTER GOODMAN M.S. CCC-SLP” Practice Location

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