MEDICARE: KATHY GOSS

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	ISW21643	FL
2	104100000X	Social Worker	116339	IL

General Provider Information

NPI Number	:	1649073669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY GOSS

Provider Business Mailing Address
First Line	:	1114 DEMOCRACY DR
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-6431
Country	:	US
Telephone Number	:	407-457-7297
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 E LAKE ST
Second Line	:
City	:	ADDISON
State	:	IL
Zip	:	60101-2886
Country	:	US
Telephone Number	:	312-600-5057
Fax Number	:

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

Provider Enumeration Date	:	03/27/2025
Last Update Date	:	03/27/2025

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Directions to “ KATHY GOSS ” Practice Location

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