MEDICARE: JORDAN GOSLIN LCSW

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	1041C0700X	Clinical Social Worker	0904014736	VA

General Provider Information

NPI Number	:	1447954433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN GOSLIN LCSW

Provider Business Mailing Address
First Line	:	6840 FOUNTAIN VISTA CIR
Second Line	:
City	:	FOUNTAIN
State	:	CO
Zip	:	80817-4708
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 COCHRANE CIR
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4613
Country	:	US
Telephone Number	:	719-526-5050
Fax Number	:

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

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	03/10/2026

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