Ann M Goedken, MS, LCSW,LPC
Individual provider Active NPI Clinical Social Worker · Cottage Grove, WI
NPI 1003081084 · NPPES record last updated Apr 29, 2008
Key facts
- NPI
- 1003081084
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 790-123 (WI)
- Practice address
- 747B Crawford Dr
Cottage Grove, WI 53527-9671 - Phone
- (608) 839-1979
- NPI assigned
- Apr 29, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201-125 | WI | MD | Counselor |
| 790-123 | WI | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 201-125 | WI | |
| Clinical Social Worker | 1041C0700X | 790-123 | WI | Yes |
Addresses
Primary practice location
747B Crawford Dr
Cottage Grove, WI 53527-9671
Mailing address
747B Crawford Dr
Cottage Grove, WI 53527-9671
Phone (608) 839-1979
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39669100 | Medicaid | WI |
Other providers in Cottage Grove, WI
- Ashley Jane Fielek
- Jeffrey A Fischer
- Javier Eugenio Font
- Kylie Ford
- Sheri L. Gehrke
- Golden Independence LLC
- Juliana Gonzalez Calderon
- Susan Kay Gorton
- Beatriz Gissell Guerrero Ramirez
- Latris R Hamilton
All providers in Cottage Grove, WI · Clinical Social Worker in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.