Provider Demographics
NPI:1013216050
Name:GOODWIN, JEAN MARIE (MSW)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:MARIE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 E SPEER BLVD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-3719
Mailing Address - Country:US
Mailing Address - Phone:303-810-8053
Mailing Address - Fax:720-917-1000
Practice Address - Street 1:825 E SPEER BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3719
Practice Address - Country:US
Practice Address - Phone:303-810-8053
Practice Address - Fax:720-917-1000
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9929001041C0700X
CO04955231041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool