Provider Demographics
NPI:1720727092
Name:GOEPPNER, DOUGLAS RAYMOND (MSW,LSW)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:RAYMOND
Last Name:GOEPPNER
Suffix:
Gender:M
Credentials:MSW,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENGLISH
Mailing Address - State:IN
Mailing Address - Zip Code:47118-3699
Mailing Address - Country:US
Mailing Address - Phone:812-338-2756
Mailing Address - Fax:
Practice Address - Street 1:523 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ENGLISH
Practice Address - State:IN
Practice Address - Zip Code:47118-3699
Practice Address - Country:US
Practice Address - Phone:812-338-2756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33005501A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker