Provider Demographics
NPI:1427875947
Name:GOODEN, ASHLEY (CHW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:GOODEN
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3229 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-3627
Mailing Address - Country:US
Mailing Address - Phone:409-789-2845
Mailing Address - Fax:
Practice Address - Street 1:3229 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568-3627
Practice Address - Country:US
Practice Address - Phone:409-789-2845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11705172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker