Provider Demographics
NPI:1467017095
Name:GOODMAN, KATHERINE (MSW, LICSW, LADC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MSW, LICSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 WYCLIFF ST STE W210
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1272
Mailing Address - Country:US
Mailing Address - Phone:612-424-0434
Mailing Address - Fax:877-905-7069
Practice Address - Street 1:2303 WYCLIFF ST STE W210
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114
Practice Address - Country:US
Practice Address - Phone:612-424-0434
Practice Address - Fax:877-905-7069
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN274101041C0700X
MN305348101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)