MEDICARE: SARA JEAN GOODRUM

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
1	225800000X	Recreation Therapist

General Provider Information

NPI Number	:	1235091133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA JEAN GOODRUM

Provider Business Mailing Address
First Line	:	2304 33RD AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1464
Country	:	US
Telephone Number	:	612-217-1014
Fax Number	:

Provider Business Practice Location Address
First Line	:	2304 33RD AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1464
Country	:	US
Telephone Number	:	612-217-1014
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2025
Last Update Date	:	12/02/2025

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Directions to “ SARA JEAN GOODRUM ” Practice Location

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