Provider Demographics
NPI:1346086105
Name:GODDARD, JENNIFER (BCDNH)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GODDARD
Suffix:
Gender:F
Credentials:BCDNH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4036
Mailing Address - Country:US
Mailing Address - Phone:856-340-9326
Mailing Address - Fax:
Practice Address - Street 1:141 N MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-2055
Practice Address - Country:US
Practice Address - Phone:865-340-9326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach