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General NPI Number Information
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NPI Number | 1649073669
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Entity Type | Individual
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Provider Name | KATHY GOSS
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Gender | Female
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 211 E LAKE ST
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City | ADDISON
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State | IL
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Zip | 60101-2886
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Country | US
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Telephone | 312-600-5057
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Fax |
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Provider Business Mailing Address
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Address Line | 1114 DEMOCRACY DR
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City | HAINES CITY
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State | FL
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Zip | 33844-6431
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Country | US
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Telephone | 407-457-7297
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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 | ISW21643
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 116339
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License Number State | IL
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