Provider Demographics
NPI:1336790807
Name:GOSLIN, AMANDA (MA, TLMFT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GOSLIN
Suffix:
Gender:F
Credentials:MA, TLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 SIERRA DR NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-6524
Mailing Address - Country:US
Mailing Address - Phone:319-432-4108
Mailing Address - Fax:
Practice Address - Street 1:1754 5TH ST
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1819
Practice Address - Country:US
Practice Address - Phone:319-351-1949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA096035106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist