Individual
MRS. ANNELIESE MARIAH GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
363 W LINCOLN TRAIL BLVD, RADCLIFF, KY 40160-3302
(270) 352-1133
Mailing address
1115 REGENCY WAY APT C, ELIZABETHTOWN, KY 42701-7181
(803) 335-9085
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-125102
KY
Other
Enumeration date
06/24/2020
Last updated
07/05/2022
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