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General NPI Number Information
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NPI Number | 1477389443
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Entity Type | Individual
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Provider Name | DUSTIN GODWIN LMSW
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Gender | Male
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 801 S WOODLAWN AVE STE 15
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City | O FALLON
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State | MO
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Zip | 63366-7647
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Country | US
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Telephone | 636-379-1779
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Fax |
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Provider Business Mailing Address
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Address Line | 345 HIGHGROVE PLACE DR
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City | O FALLON
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State | MO
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Zip | 63366-4384
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Country | US
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Telephone | 314-583-2705
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2024033725
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License Number State | MO
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