Provider Demographics
NPI:1780454504
Name:GODDARD, TAMARA FAY (M A)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:FAY
Last Name:GODDARD
Suffix:
Gender:F
Credentials:M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 LARK PL
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-7345
Mailing Address - Country:US
Mailing Address - Phone:970-214-1980
Mailing Address - Fax:
Practice Address - Street 1:331 LARK PL
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-7345
Practice Address - Country:US
Practice Address - Phone:970-214-1980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001703235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist