Provider Demographics
NPI:1225474398
Name:GOODMAN, CHRISTOPHER ALLEN (BS)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ALLEN
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 HOMECREST ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-1527
Mailing Address - Country:US
Mailing Address - Phone:573-344-3565
Mailing Address - Fax:
Practice Address - Street 1:935 HIGHWAY V V
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857
Practice Address - Country:US
Practice Address - Phone:573-888-0642
Practice Address - Fax:573-888-8833
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator