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General NPI Number Information
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NPI Number | 1326265844
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Entity Type | Individual
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Provider Name | JODI LYNN GOODIN PSYD
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Gender | Female
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 1329 APPLEGATE LN SOUTHERN INDIANA REHABILITATION HOSPTIAL
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City | CLARKSVILLE
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State | IN
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Zip | 47129
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Country | US
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Telephone | 812-283-5992
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Fax | 812-283-7069
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Provider Business Mailing Address
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Address Line | 1329 APPLEGATE LN SOUTHERN INDIANA REHABILITATION HOSPITAL
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City | CLARKSVILLE
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State | IN
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Zip | 47129
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Country | US
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Telephone | 812-283-5992
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Fax | 812-283-7069
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34005066A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20042191A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 20042191A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 34005066A
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License Number State | IN
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