| Doctor Name: | MRS. PHYLLIS JEAN GOLDBACH |
| NPI Number: | 1396996682 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNS |
| License Number: | 08973 |
| Business Practice Address: | 401 Bounty Way Apt 209 Avon Lake, OH - 440122479 |
| Business Phone Number: | 4409339475 |
| Business Fax Number: | |
| Mailing Address: | 401 Bounty Way Apt 209, AVON LAKE |
| State: | OH |
| Postal Code: | 440122479 |
| Phone Number: | 4409339475 |
| Fax Number: | |
| NPI Enumeration Date: | 10/04/2008 |
| NPI Last Update Date: | 10/04/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SP0809X |
| License Number: | 08973 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Psych/Mental Health, Adult |
| Taxonomy Definition: | |