MEDICARE: ANGELA LISA GOODE-TAYLOR LICSW, RN

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	LW00008492	WA
2	163W00000X	Registered Nurse	RN61078832	WA

General Provider Information

NPI Number	:	1891844742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA LISA GOODE-TAYLOR LICSW, RN

Provider Business Mailing Address
First Line	:	18434 NUTMEG ST SW
Second Line	:
City	:	ROCHESTER
State	:	WA
Zip	:	98579-9115
Country	:	US
Telephone Number	:	360-827-2049
Fax Number	:

Provider Business Practice Location Address
First Line	:	9330 59TH AVE SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-2858
Country	:	US
Telephone Number	:	360-620-5015
Fax Number	:

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	01/10/2023

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