Active NPI
Rochelle Marie Goodrich, LICSW
- Clinical Social Worker
- Cloquet, MN
National Provider Identifier
1124170840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 22104
- Practice address
- Fond Du Lac Human Services Division
927 Trettel Lane
Cloquet, MN 55720 - Phone
- (218) 879-1227
- Fax
- (218) 878-2188
- NPI assigned
- Jan 16, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 22104 | MN | Primary |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 301771 | MN |
Addresses
Primary practice location
Fond Du Lac Human Services Division
927 Trettel Lane
Cloquet, MN 55720
Mailing address
1439 N 8TH Ave East
Duluth, MN 55805
Phone (218) 464-8136
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NPPOO | Other | MN | FDLHSD MEDICARE |
| 666815100 | Other | MN | FDLHSD MEDICAIDE |
Other names 1
- Rochelle Marie Kredovski
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 301771 | MN | MD | Addiction (Substance Use Disorder) Counselor |
Interoperability endpoints
- rochelle.goodrich.p1@direct.fonddulachsd.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498780800000",
"number": "1124170840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1439 N 8TH AVE EAST",
"city": "DULUTH",
"state": "MN",
"postal_code": "55805",
"telephone_number": "218-464-8136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "FOND DU LAC HUMAN SERVICES DIVISION",
"address_2": "927 TRETTEL LANE",
"city": "CLOQUET",
"state": "MN",
"postal_code": "55720",
"telephone_number": "218-879-1227",
"fax_number": "218-878-2188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODRICH",
"first_name": "ROCHELLE",
"middle_name": "MARIE",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-16",
"last_updated": "2017-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "22104",
"primary": true
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MN",
"license": "301771",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FDLHSD MEDICARE",
"identifier": "NPPOO",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FDLHSD MEDICAIDE",
"identifier": "666815100",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "ROCHELLE",
"last_name": "KREDOVSKI",
"middle_name": "MARIE",
"credential": "LACD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Cloquet, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.