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NPI Code Detail

MEDICARE: JOANNA MARIE GOODMAN

MEDICARE: JOANNA MARIE 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 Worker6851111053MI

General Provider Information

NPI Number : 1720735103
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOANNA MARIE GOODMAN
Provider Business Mailing Address
First Line : 34841 VETERANS PLZ
Second Line :
City : WAYNE
State : MI
Zip : 48184-1733
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 34841 VETERANS PLZ
Second Line :
City : WAYNE
State : MI
Zip : 48184-1733
Country : US
Telephone Number : 734-600-7873
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2022
Last Update Date : 12/15/2025

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