Individual
EVAN GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
909 E STATE BLVD, FORT WAYNE, IN 46805-3404
(260) 482-9125
Mailing address
909 E STATE BLVD, FORT WAYNE, IN 46805-3404
(260) 482-9125
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20043165A
IN
Other
Enumeration date
11/23/2016
Last updated
11/26/2018
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