Provider Demographics
NPI:1386872414
Name:GOODSON, AMBER MARIE (LAC DIPLO OF OM)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:GOODSON
Suffix:
Gender:F
Credentials:LAC DIPLO OF OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 8TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-4973
Mailing Address - Country:US
Mailing Address - Phone:303-681-8131
Mailing Address - Fax:
Practice Address - Street 1:116 8TH ST STE 2
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-4973
Practice Address - Country:US
Practice Address - Phone:303-681-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1430171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist