Provider Demographics
NPI:1861637563
Name:GOODE, DEBORAH (MSE,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:
Last Name:GOODE
Suffix:
Gender:F
Credentials:MSE,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 PAR FORE DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7270
Mailing Address - Country:US
Mailing Address - Phone:501-868-4740
Mailing Address - Fax:501-868-6498
Practice Address - Street 1:20900 ROLAND HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:AR
Practice Address - Zip Code:72135-9685
Practice Address - Country:US
Practice Address - Phone:501-868-4740
Practice Address - Fax:501-868-6498
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP260235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist