Individual
KELLY ROSS GOODWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
916 SW 17TH ST STE 202, REDMOND, OR 97756-2572
(541) 706-2768
Mailing address
2500 NE NEFF RD, BEND, OR 97701-6015
(541) 382-4321
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
6491
OR
1041C0700X
Clinical Social Worker
Primary
L6491
OR
Other
Enumeration date
09/21/2020
Last updated
06/16/2022
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