Individual
MS. ANN M GOEDKEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LCSW,LPC
Contact information
Practice address
747B CRAWFORD DR, COTTAGE GROVE, WI 53527-9671
(608) 839-1979
Mailing address
747B CRAWFORD DR, COTTAGE GROVE, WI 53527-9671
(608) 839-1979
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
201-125
WI
1041C0700X
Clinical Social Worker
Primary
790-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39669100
—
WI
Enumeration date
04/29/2008
Last updated
04/29/2008
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