Provider Demographics
NPI:1437950334
Name:GOODLETT, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:GOODLETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 NW 32ND LN
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-1470
Mailing Address - Country:US
Mailing Address - Phone:515-943-1471
Mailing Address - Fax:
Practice Address - Street 1:2816 NW 32ND LN
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-1470
Practice Address - Country:US
Practice Address - Phone:515-943-1471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities