Doctor Name: | JANE GOODSON |
NPI Number: | 1659748036 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | LMSW-28489 |
Business Practice Address: | 125 Commerce St Ste N Mccall, ID - 836385192 |
Business Phone Number: | 2086342962 |
Business Fax Number: | |
Mailing Address: | Po Box 1117, MCCALL |
State: | ID |
Postal Code: | 836381117 |
Phone Number: | 2089498126 |
Fax Number: | |
NPI Enumeration Date: | 09/01/2015 |
NPI Last Update Date: | 09/01/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LMSW-28489 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |