MEDICARE: MEGAN GOUDIE SWLC

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	38688	MT

General Provider Information

NPI Number	:	1932797214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN GOUDIE SWLC

Provider Business Mailing Address
First Line	:	660 FERNDALE DR
Second Line	:
City	:	BIGFORK
State	:	MT
Zip	:	59911-6517
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 JEWEL BASIN CT STE 3D
Second Line	:
City	:	BIGFORK
State	:	MT
Zip	:	59911-6294
Country	:	US
Telephone Number	:	406-201-9711
Fax Number	:

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

Provider Enumeration Date	:	01/04/2021
Last Update Date	:	01/04/2021

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