Doctor Name: | DR. SUSAN WINDHAM GOODWYN |
NPI Number: | 1003106279 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | PSY24190 |
Business Practice Address: | 301 Alamo Dr A1 Vacaville, CA - 956884246 |
Business Phone Number: | 7074558541 |
Business Fax Number: | 7074557435 |
Mailing Address: | 3358 Mix Canyon Rd, VACAVILLE |
State: | CA |
Postal Code: | 956889012 |
Phone Number: | 7074558541 |
Fax Number: | 7074557435 |
NPI Enumeration Date: | 04/08/2011 |
NPI Last Update Date: | 04/13/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY24190 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |