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General NPI Number Information
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NPI Number | 1932990033
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Entity Type | Individual
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Provider Name | KATIE LYNN GOODMAN LMSW
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Gender | Female
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Dates
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Enumeration Date | 05/16/2025
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 1750 S BRENTWOOD BLVD STE 205
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City | SAINT LOUIS
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State | MO
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Zip | 63144-1315
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Country | US
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Telephone | 314-881-0350
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Fax | 816-508-3535
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Provider Business Mailing Address
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Address Line | 1937 ROYAL HEIR DR
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City | O FALLON
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State | MO
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Zip | 63366-4357
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Country | US
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Telephone | 618-407-5212
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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 | 2023017842
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License Number State | MO
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