Provider Demographics
NPI:1699077040
Name:GOODRICH, CLAIRE LEIGH (MA, CCC, SLP)
Entity type:Individual
Prefix:MRS
First Name:CLAIRE
Middle Name:LEIGH
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:MA, CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10193 BEAR VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5961
Mailing Address - Country:US
Mailing Address - Phone:904-260-1479
Mailing Address - Fax:904-260-1479
Practice Address - Street 1:10193 BEAR VALLEY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5961
Practice Address - Country:US
Practice Address - Phone:904-260-1479
Practice Address - Fax:904-260-1479
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5321235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist