Provider Demographics
NPI:1467017095
Name:GOODMAN, KATHERINE (MSW, LICSW, LADC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:
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 1:7301 OHMS LN STE 450
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2339
Mailing Address - Country:US
Mailing Address - Phone:612-702-8389
Mailing Address - Fax:
Practice Address - Street 1:7301 OHMS LN STE 450
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2339
Practice Address - Country:US
Practice Address - Phone:612-208-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305348101YA0400X
MN274101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)