Individual
PRISCILLA ANNE GOODWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PROF. FOSTER HOME
Contact information
Practice address
1710 S 74TH ST, MESA, AZ 85209-4136
(480) 981-5555
Mailing address
1710 S 74TH ST, MESA, AZ 85209-4136
(480) 981-5555
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
5102
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5102
PROF. FOSTER HOME
AZ
Enumeration date
01/26/2007
Last updated
03/09/2009
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