Individual
ICEY DAWN GOODRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
105 MAPLEWOOD DR, FAIRMONT, WV 26554-2147
(304) 366-8779
Mailing address
7 HUNTING HILL DR, MANNINGTON, WV 26582-8142
(304) 508-2156
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
01/03/2021
Last updated
01/03/2021
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