Provider Demographics
NPI:1962720516
Name:GOODALE, BEVERLY A (MA, CCC, SLP)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:GOODALE
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 1:45 LIMERICK RD
Mailing Address - Street 2:
Mailing Address - City:ARUNDEL
Mailing Address - State:ME
Mailing Address - Zip Code:04046-8128
Mailing Address - Country:US
Mailing Address - Phone:297-323-3832
Mailing Address - Fax:
Practice Address - Street 1:45 LIMERICK RD
Practice Address - Street 2:
Practice Address - City:ARUNDEL
Practice Address - State:ME
Practice Address - Zip Code:04046-8128
Practice Address - Country:US
Practice Address - Phone:207-323-3832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP874235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist