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NPI Code Detail

MEDICARE: SHANNON KIVA GOODMAN

MEDICARE: SHANNON KIVA GOODMAN
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1285346635
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON KIVA GOODMAN
Provider Business Mailing Address
First Line : 6615 ANTHONY AVE
Second Line :
City : GARDEN GROVE
State : CA
Zip : 92845-2207
Country : US
Telephone Number : 502-649-2110
Fax Number :
Provider Business Practice Location Address
First Line : 6615 ANTHONY AVE
Second Line :
City : GARDEN GROVE
State : CA
Zip : 92845-2207
Country : US
Telephone Number : 502-649-2110
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2022
Last Update Date : 12/16/2022

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Directions to “ SHANNON KIVA GOODMAN ” Practice Location

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