MEDICARE: JENNA GOODWIN LCSW

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	101YM0800X	Mental Health Counselor	10205-C	AR

General Provider Information

NPI Number	:	1366891269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA GOODWIN LCSW

Provider Business Mailing Address
First Line	:	P.O. BOX 679
Second Line	:
City	:	MORRILTON
State	:	AR
Zip	:	72110-0679
Country	:	US
Telephone Number	:	501-354-4589
Fax Number	:	501-354-5410

Provider Business Practice Location Address
First Line	:	1200 W. WALNUT ST
Second Line	:	SUITE A&B
City	:	ROGERS
State	:	AR
Zip	:	72756-3578
Country	:	US
Telephone Number	:	479-278-7028
Fax Number	:	479-278-2092

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

Provider Enumeration Date	:	06/10/2016
Last Update Date	:	03/25/2026

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