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NPI Code Detail

MEDICARE: SUONG JANA GOODHART LMFT

MEDICARE:   SUONG JANA GOODHART  LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist1888MN

General Provider Information

NPI Number : 1043450364
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUONG JANA GOODHART LMFT
Provider Business Mailing Address
First Line : 2649 PARK AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1006
Country : US
Telephone Number : 612-676-1604
Fax Number : 612-379-8235
Provider Business Practice Location Address
First Line : 2649 PARK AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1006
Country : US
Telephone Number : 612-676-1604
Fax Number : 612-379-8235
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2009
Last Update Date : 02/26/2009

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Directions to “ SUONG JANA GOODHART LMFT” Practice Location

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