Basic Information
| Provider Information | |||||||||
| NPI: | 1982128021 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOODWIN | ||||||||
| FirstName: | QUINN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 WAUKEGAN RD | ||||||||
| Address2: | |||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600255154 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 41 WAUKEGAN RD. | ||||||||
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| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477076744 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2017 | ||||||||
| LastUpdateDate: | 07/31/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 242004563 | IL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.