Shannon Dannielle Goodwin, LMSW, AAPS

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

4137 Issued in KS

Practice address

2627 E Central Ave
Wichita, KS 67214-4608

Phone

(316) 684-5300

Fax

(316) 684-6336

NPI assigned

Feb 1, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Blue Moon Therapy LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wichita, KS
  • NPI 1205319472
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592265600000",
    "number": "1386782746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 E JUMP ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672161360",
            "telephone_number": "316-304-3585",
            "fax_number": "316-684-6336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2627 E CENTRAL AVE",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672144608",
            "telephone_number": "316-684-5300",
            "fax_number": "316-684-6336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODWIN",
        "first_name": "SHANNON",
        "middle_name": "DANNIELLE",
        "name_prefix": "Ms.",
        "credential": "LMSW, AAPS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-01",
        "last_updated": "2020-06-16",
        "certification_date": "2020-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "KS",
            "license": "619",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KS",
            "license": "4137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda M Goodson, DO
• Sally Lynne Goodson, R.PH.
• Goodwill Industries Easter Seals of KS, Inc.
• Myreik Goodwin-Lagree
• Adam Matthew Goodwin, DO
• Heidi Goolsby, AAPS
• Praveena Gorantla, M.D
• Saritha Gorantla, M.D.
• Suman Gorantla, DMD
• Jeffrey David Gorcos, MD

• Clinical Social Worker in Wichita, KS
• Providers in Wichita, KS by specialty
• Clinical Social Worker in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.