Active NPI
Michelle Goodman, MS,CCC
- Speech-Language Pathologist
- Marietta, GA
National Provider Identifier
1528131836
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP005627
- Practice address
- 2745 Stillwater Lake LN
Marietta, GA 30066-7904 - Phone
- (678) 612-5693
- NPI assigned
- Nov 16, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP005627 | GA | Primary |
Addresses
Primary practice location
2745 Stillwater Lake LN
Marietta, GA 30066-7904
Mailing address
2745 Stillwater Lake LN
Marietta, GA 30066-7904
Phone (678) 612-5693
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 939742314B | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP005627 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311552000000",
"number": "1528131836",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2745 STILLWATER LAKE LN",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300667904",
"telephone_number": "678-612-5693",
"fax_number": "678-612-5693"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2745 STILLWATER LAKE LN",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300667904",
"telephone_number": "678-612-5693"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODMAN",
"first_name": "MICHELLE",
"name_prefix": "Ms.",
"credential": "MS,CCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-16",
"last_updated": "2011-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "SLP005627",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "939742314B",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.