Provider Demographics
NPI:1104860998
Name:GOODMAN, BARBARA G (MSSW)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:G
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-9439
Mailing Address - Country:US
Mailing Address - Phone:608-768-4545
Mailing Address - Fax:608-768-4646
Practice Address - Street 1:2213 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-9439
Practice Address - Country:US
Practice Address - Phone:608-768-4545
Practice Address - Fax:608-768-4646
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40950600Medicaid
WI000080013Medicare ID - Type Unspecified