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General NPI Number Information
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NPI Number | 1013257484
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Entity Type | Individual
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Provider Name | SHARON L GOEDKOOP LICSW, PLLC
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Gender | Female
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Dates
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Enumeration Date | 02/22/2013
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Last Update Date | 10/23/2013
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Provider Practice Location Address
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Address Line | 2458 CHRISTIAN ST SUITE 214
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City | WHITE RIVER JUNCTION
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State | VT
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Zip | 05001-9855
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Country | US
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Telephone | 802-359-2553
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 842
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City | WILDER
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State | VT
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Zip | 05088-0842
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Country | US
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Telephone | 802-359-2553
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 0890001132
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0890001132
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License Number State | VT
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