1720262900 NPI number — MRS. JOAN HUNTER GODSEY MSW

Table of content: MRS. JOAN HUNTER GODSEY MSW (NPI 1720262900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720262900 NPI number — MRS. JOAN HUNTER GODSEY MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GODSEY
Provider First Name:
JOAN
Provider Middle Name:
HUNTER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GODSEY
Provider Other First Name:
JOAN
Provider Other Middle Name:
HUNTER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1720262900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2809 WASHINGTON AVE
Provider Second Line Business Mailing Address:
STE R
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47421-5310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-278-8707
Provider Business Mailing Address Fax Number:
877-366-6099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2809 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
STE R
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47421-5310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-278-8707
Provider Business Practice Location Address Fax Number:
877-366-6099
Provider Enumeration Date:
12/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 34006152A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)