Provider Demographics
NPI:1194239376
Name:GOODWIN, LINDSAY
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 W 15TH ST UNIT 303
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-3688
Mailing Address - Country:US
Mailing Address - Phone:312-343-0503
Mailing Address - Fax:
Practice Address - Street 1:1640 W DIVISION ST FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3939
Practice Address - Country:US
Practice Address - Phone:312-548-8993
Practice Address - Fax:312-589-7314
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-26
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198001301171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist