Provider Demographics
NPI:1235487463
Name:GOODBAN, JOANNA (LAC, RMT, MSW)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:GOODBAN
Suffix:
Gender:F
Credentials:LAC, RMT, MSW
Other - Prefix:
Other - First Name:SA'BURA
Other - Middle Name:
Other - Last Name:GOODBAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SAME
Mailing Address - Street 1:16580 W 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-1657
Mailing Address - Country:US
Mailing Address - Phone:917-664-9782
Mailing Address - Fax:
Practice Address - Street 1:16580 W 51ST AVE
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-1657
Practice Address - Country:US
Practice Address - Phone:917-664-9782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1800171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist