Provider Demographics
NPI:1316337645
Name:GOODRICH, HALEY (RD, LDN)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4099 WILLIAM PENN HWY
Mailing Address - Street 2:SUITE 202, JONNET BUILDING
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2521
Mailing Address - Country:US
Mailing Address - Phone:979-814-0702
Mailing Address - Fax:
Practice Address - Street 1:4099 WILLIAM PENN HWY
Practice Address - Street 2:SUITE 202, JONNET BUILDING
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2521
Practice Address - Country:US
Practice Address - Phone:979-814-0702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005398133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered