Provider Demographics
NPI:1124306246
Name:GOODALL, STARLYN (MA)
Entity type:Individual
Prefix:
First Name:STARLYN
Middle Name:
Last Name:GOODALL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WARWICK CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-1859
Mailing Address - Country:US
Mailing Address - Phone:517-358-5688
Mailing Address - Fax:
Practice Address - Street 1:14 WARWICK CT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-1859
Practice Address - Country:US
Practice Address - Phone:517-358-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program