Provider Demographics
NPI:1164123857
Name:GOODALL, RILEY HAYES (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:HAYES
Last Name:GOODALL
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:MICHELE
Other - Last Name:GOODALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:1485 WINTERGREEN CT
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-9586
Mailing Address - Country:US
Mailing Address - Phone:763-614-6766
Mailing Address - Fax:
Practice Address - Street 1:600 MARKET ST STE 220
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-4588
Practice Address - Country:US
Practice Address - Phone:651-213-9280
Practice Address - Fax:651-433-7122
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN237491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical