Individual
SHARON L GOEDKOOP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW, PLLC
Contact information
Practice address
2458 CHRISTIAN ST, SUITE 214, WHITE RIVER JUNCTION, VT 05001-9855
(802) 359-2553
Mailing address
PO BOX 842, WILDER, VT 05088-0842
(802) 359-2553
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
0890001132
VT
1041C0700X
Clinical Social Worker
Primary
0890001132
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013257484
BLUE CROSS/BLUE SHIELD
VT
05
—
1021546
—
VT
05
—
3086010
—
NH
01
—
4583988
CIGNA
VT
Enumeration date
02/22/2013
Last updated
10/23/2013
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