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NPI Code Detail

MEDICARE: DELLA GOODWIN LCSW

MEDICARE: DELLA 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
11041C0700XClinical Social Worker000639MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568468411
Entity Type Code : Individual
Provider Name (Legal Business Name) : DELLA GOODWIN LCSW
Provider Business Mailing Address
First Line : PO BOX 5681
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65801-5681
Country : US
Telephone Number : 417-831-0150
Fax Number : 417-831-0155
Provider Business Practice Location Address
First Line : 440 E TAMPA ST
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65806-1131
Country : US
Telephone Number : 417-831-0150
Fax Number : 417-831-0155
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2005
Last Update Date : 10/28/2009

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Directions to “ DELLA GOODWIN LCSW” Practice Location

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