Provider Demographics
NPI:1720054513
Name:GODSEY, MARDA L (LISW)
Entity Type:Individual
Prefix:
First Name:MARDA
Middle Name:L
Last Name:GODSEY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG 5980 DESERT STORM
Mailing Address - Street 2:BLANCHFIELD ARMY COMMUNITY HOSPITAL JOEL DRIVE
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223
Mailing Address - Country:US
Mailing Address - Phone:270-798-8601
Mailing Address - Fax:
Practice Address - Street 1:310 GINNIE LN
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-4724
Practice Address - Country:US
Practice Address - Phone:270-885-0196
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI82021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical