Organization
GOODWILL GREATER CLEVELAND AND EAST CENTRAL OHIO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK TREW (CHIEF OPERATING OFFICER)
(330) 445-1035
Entity
Organization
Contact information
Practice address
408 NINTH STREET SW, CANTON, OH 44707-4714
(330) 445-1035
(330) 454-1014
Mailing address
408 NINTH STREET SW, CANTON, OH 44707
(330) 445-1059
(330) 454-1014
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
A00436
OH
235Z00000X
Speech-Language Pathologist
SP2281
OH
235Z00000X
Speech-Language Pathologist
SP3189
OH
235Z00000X
Speech-Language Pathologist
SP8183
OH
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0303042
—
OH
05
—
3303884
—
OH
01
—
733018
BUCKEYE-MEDICAID HMO
OH
Enumeration date
04/20/2007
Last updated
12/02/2022
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