Individual
ANGELIQUE D. GOODHUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7434 S STATE ST, SOUTH VALLEY MENTAL HEALTH, MIDVALE, UT 84047-2014
(801) 566-4432
Mailing address
1901 S BERKELEY ST, SALT LAKE CITY, UT 84108-3201
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
963253611205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107007839101
INTERMOUNTAIN HEALTHCARE
UT
01
—
662594
DESERET MUTUAL
UT
01
—
942938348
CHAMPUS
UT
01
—
942938348G02
EDUCATORS MUTUAL
UT
Enumeration date
12/20/2005
Last updated
01/10/2022
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