Provider Demographics
NPI:1669915252
Name:GOODON, MARION STEVE JR (IADC)
Entity type:Individual
Prefix:MR
First Name:MARION
Middle Name:STEVE
Last Name:GOODON
Suffix:JR
Gender:M
Credentials:IADC
Other - Prefix:MR
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:DIRKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IADC
Mailing Address - Street 1:800 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1317
Mailing Address - Country:US
Mailing Address - Phone:712-234-2300
Mailing Address - Fax:
Practice Address - Street 1:800 5TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1317
Practice Address - Country:US
Practice Address - Phone:712-234-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16004101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)