Individual
KELLY MARIE GOODWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2990 N PERRYVILLE RD, ROCKFORD, IL 61107-6814
(815) 469-1500
Mailing address
2990 N PERRYVILLE RD, ROCKFORD, IL 61107-6814
(815) 469-1500
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-18-31541
IL
Other
Enumeration date
10/11/2018
Last updated
07/12/2022
About Stedi
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