Icey Dawn Goodrich

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

105 Maplewood Dr
Fairmont, WV 26554-2147

Phone

(304) 366-8779

NPI assigned

Jan 3, 2021

Last updated

Jan 3, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609632000000",
    "number": "1720676059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 HUNTING HILL DR",
            "city": "MANNINGTON",
            "state": "WV",
            "postal_code": "265828142",
            "telephone_number": "304-508-2156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 MAPLEWOOD DR",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265542147",
            "telephone_number": "304-366-8779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODRICH",
        "first_name": "ICEY",
        "middle_name": "DAWN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-03",
        "last_updated": "2021-01-03",
        "certification_date": "2021-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Candace Golaszewski, MSW
• Gold Key Occupational Therapy
• Taylor Paiva Goldsmith, BS
• Amanda Gomez
• Helen Mae Goodrich
• Claudia A Goodwin, MD
• Sherry Goodwin
• Jenna Paige Goots
• Tiffany Gore
• Luthor Goudy

• Community Health Worker in Fairmont, WV
• Providers in Fairmont, WV by specialty
• Community Health Worker in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.