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NPI Code Detail

MEDICARE: JUDY G GOODSON LMSW

MEDICARE: JUDY G GOODSON LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker1670-MAR

General Provider Information

NPI Number : 1093741514
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDY G GOODSON LMSW
Provider Business Mailing Address
First Line : 4253 N CROSSOVER RD
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-4593
Country : US
Telephone Number : 479-521-5731
Fax Number : 479-521-4926
Provider Business Practice Location Address
First Line : 10301 MAYO DR
Second Line :
City : BARLING
State : AR
Zip : 72923-1660
Country : US
Telephone Number : 479-494-5700
Fax Number : 479-484-8142
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2006
Last Update Date : 07/08/2007

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