Provider Demographics
NPI:1306520317
Name:GOODMAN, CLARE RUTHMARIE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:CLARE
Middle Name:RUTHMARIE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:CLARE
Other - Middle Name:RUTHMARIE
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26W171 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-6002
Mailing Address - Country:US
Mailing Address - Phone:630-909-7055
Mailing Address - Fax:
Practice Address - Street 1:26W171 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-6002
Practice Address - Country:US
Practice Address - Phone:630-909-7055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.014411235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist