Provider Demographics
NPI:1679977094
Name:GOODSITT, DANA (LMT)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:GOODSITT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:SCHLAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1804 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-1023
Mailing Address - Country:US
Mailing Address - Phone:217-337-4313
Mailing Address - Fax:
Practice Address - Street 1:1804 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-1023
Practice Address - Country:US
Practice Address - Phone:217-337-4313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.015191225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist