Provider Demographics
NPI:1871228361
Name:GOODSPEED, LORI
Entity type:Individual
Prefix:MISS
First Name:LORI
Middle Name:
Last Name:GOODSPEED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:GOODSPEED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8610 N 91ST AVE APT 1016
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-8315
Mailing Address - Country:US
Mailing Address - Phone:480-720-6699
Mailing Address - Fax:
Practice Address - Street 1:8610 N 91ST AVE APT 1016
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-8315
Practice Address - Country:US
Practice Address - Phone:480-720-6699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health