Individual
DR. GLENN T GOODWIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
555 DAYTON ST, SUITE E, EDMONDS, WA 98020-3601
(206) 663-0816
(425) 672-8655
Mailing address
555 DAYTON ST, SUITE E, EDMONDS, WA 98020-3601
(206) 663-0816
(425) 672-8655
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PY00001999
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113963
L&I PROVIDER NO.
WA
Enumeration date
02/16/2007
Last updated
07/08/2007
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