NPIMap

Jordan Shawn Goodman, M.A.

Individual provider Active NPI Speech-Language Pathologist · Oakland, FL

NPI 1992153373 · NPPES record last updated May 16, 2018

Key facts

NPI
1992153373
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
SA15856 (FL)
Practice address
301 S Tubb St Ste A1
Oakland, FL 34760
Phone
(407) 395-9976
NPI assigned
May 26, 2016
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
SA15856FLMDSpeech-Language Pathologist
SZ7530FLMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Metamorphosis Therapy, LLC Speech-Language Pathologist Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SZ7530 FL
Speech-Language Pathologist 235Z00000X SA15856 FL Yes

Addresses

Primary practice location

301 S Tubb St Ste A1
Oakland, FL 34760

Mailing address

1565 Morningside Dr
Mount Dora, FL 32757-3628
Phone (352) 638-0172

Other practice location 1

2760 Dora Ave
Tavares, FL 32778-4970
Phone (352) 742-7837

Other providers in Oakland, FL

All providers in Oakland, FL · Speech-Language Pathologist in Florida

Sources for this page

Verify at the official NPI Registry.