Individual
JASON TALLEY GOODSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
112 BALA AVE, BALA CYNWYD, PA 19004-3025
(610) 667-6490
(610) 667-1744
Mailing address
112 BALA AVE, BALA CYNWYD, PA 19004-3025
(610) 667-6490
(610) 667-1744
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS017069
PA
Other
Enumeration date
06/19/2007
Last updated
01/24/2012
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