Healthcare Provider Details

I. General information

NPI: 1649073669
Provider Name (Legal Business Name): KATHY GOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E LAKE ST
ADDISON IL
60101-2886
US

IV. Provider business mailing address

1114 DEMOCRACY DR
HAINES CITY FL
33844-6431
US

V. Phone/Fax

Practice location:
  • Phone: 312-600-5057
  • Fax:
Mailing address:
  • Phone: 407-457-7297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW21643
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number116339
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: