Provider Demographics
NPI:1972732105
Name:GOODMAN, JAIME MARIE (SLP)
Entity type:Individual
Prefix:MS
First Name:JAIME
Middle Name:MARIE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 MAY AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-4301
Mailing Address - Country:US
Mailing Address - Phone:757-628-2466
Mailing Address - Fax:757-628-2461
Practice Address - Street 1:610 MAY AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-4301
Practice Address - Country:US
Practice Address - Phone:757-628-2466
Practice Address - Fax:757-628-2461
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA12119407235Z00000X
VA2202005801235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist