Individual
MRS. MARY JOANNE GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSW, SAC-IT
Contact information
Practice address
2842 S BUSINESS DR, SHEBOYGAN, WI 53081-6518
(920) 458-6527
(920) 458-6623
Mailing address
2842 S BUSINESS DR, SHEBOYGAN, WI 53081-6518
(920) 458-6527
(920) 458-6623
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18913-130
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100013835
—
WI
Enumeration date
06/26/2019
Last updated
06/26/2019
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