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NPI Code Detail

MEDICARE: THERESA GOSCINSKI

MEDICARE: THERESA GOSCINSKI
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
11041C0700XClinical Social Worker149011039IL

General Provider Information

NPI Number : 1801038765
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA GOSCINSKI
Provider Business Mailing Address
First Line : 5409 WAKE FOREST DR
Second Line :
City : FAIRVIEW HEIGHTS
State : IL
Zip : 62208-3970
Country : US
Telephone Number : 618-257-3497
Fax Number :
Provider Business Practice Location Address
First Line : 5409 WAKE FOREST DR
Second Line :
City : FAIRVIEW HEIGHTS
State : IL
Zip : 62208-3970
Country : US
Telephone Number : 618-257-3497
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2009
Last Update Date : 03/24/2009

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Directions to “ THERESA GOSCINSKI ” Practice Location

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