Provider Demographics
NPI:1639565872
Name:GODDARD, LINDSEY DAWN (MD)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:DAWN
Last Name:GODDARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:510 N 17TH AVE STE C
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4281
Practice Address - Country:US
Practice Address - Phone:715-849-5333
Practice Address - Fax:715-849-4083
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1893-320207N00000X, 207ND0101X, 207NS0135X
ND19657207N00000X
AZ65556207N00000X
IDMC-1248207ND0101X, 207N00000X
WAMD61065973207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology