MEDICARE: SHEILA D 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
1	1041C0700X	Clinical Social Worker	LW00005321	WA

General Provider Information

NPI Number	:	1992870539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA D GOODWIN LCSW

Provider Business Mailing Address
First Line	:	119 N COMMERCIAL ST STE 325
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-4437
Country	:	US
Telephone Number	:	360-961-4146
Fax Number	:	360-676-0752

Provider Business Practice Location Address
First Line	:	119 N COMMERCIAL ST STE 325
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-4437
Country	:	US
Telephone Number	:	360-961-4146
Fax Number	:	360-676-0752

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	07/08/2007

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