Provider Demographics
NPI:1487024956
Name:GOSHEN, SHERRY ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:ANN
Last Name:GOSHEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 N KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-1367
Mailing Address - Country:US
Mailing Address - Phone:573-547-3116
Mailing Address - Fax:
Practice Address - Street 1:12 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775
Practice Address - Country:US
Practice Address - Phone:573-547-3116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180079451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical