MEDICARE: MS. RACHEL T GOOEN LCSW, LAC

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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1235322587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHEL T GOOEN LCSW, LAC

Provider Business Mailing Address
First Line	:	838 S 5TH ST W
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-2434
Country	:	US
Telephone Number	:	406-360-7685
Fax Number	:

Provider Business Practice Location Address
First Line	:	2811 LATIMER ST
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-1698
Country	:	US
Telephone Number	:	406-728-2537
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	11/01/2011

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