|
| |
|
2458 Christian Street Suite 214 Wilder VT 05088 | |
| (802) 356-9393 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 2458 Christian Street, Wilder, Vermont |
| Authorized Official Name and Position | Sharon L. Goedkoop (LICENSED SOCIAL WORKER) |
| Authorized Official Contact | 8023569393 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 842 Wilder VT 05088-0842 Ph: (802) 356-9393 | 2458 Christian Street Suite 214 Wilder VT 05088 Ph: (802) 356-9393 |
| NPI Number | 1942644216 |
|---|---|
| Provider Enumeration Date | 04/17/2013 |
| Last Update Date | 02/14/2023 |
| Certification Date | 02/14/2023 |
| Medicare PECOS PAC ID | 5597993063 |
|---|---|
| Medicare Enrollment ID | O20140107000782 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942644216 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 089.0001132 (Vermont) | Primary |
| Provider Name | Sharon L. Goedkoop |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013257484 PECOS PAC ID: 6406084979 Enrollment ID: I20140108000021 |