Provider Demographics
NPI:1316317019
Name:GOODALL, JESSICA NICOLE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:NICOLE
Last Name:GOODALL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:NICOLE
Other - Last Name:WENKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:5112 NW TAYLOR RD.
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312
Mailing Address - Country:US
Mailing Address - Phone:360-373-2536
Mailing Address - Fax:360-373-4934
Practice Address - Street 1:5112 NW TAYLOR RD.
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312
Practice Address - Country:US
Practice Address - Phone:360-373-2536
Practice Address - Fax:360-373-4934
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist