Provider Demographics
NPI:1174959100
Name:GOODWIN, GILLIAN C (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:GILLIAN
Middle Name:C
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 SCHOOLHOUSE POINT LN
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-7694
Mailing Address - Country:US
Mailing Address - Phone:347-239-7096
Mailing Address - Fax:
Practice Address - Street 1:1000 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3944
Practice Address - Country:US
Practice Address - Phone:360-582-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist