Individual
CASEY GODERUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
634 PRESSLEY ST, SANTA ROSA, CA 95404-5526
(707) 573-6955
Mailing address
420 E COTATI AVE, COTATI, CA 94931-4442
(707) 795-4336
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
03/29/2023
Last updated
07/16/2025
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