Provider Demographics
NPI:1386782746
Name:GOODWIN, SHANNON DANNIELLE (LMSW, AAPS)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:DANNIELLE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LMSW, AAPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 E JUMP ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67216-1360
Mailing Address - Country:US
Mailing Address - Phone:316-304-3585
Mailing Address - Fax:316-684-6336
Practice Address - Street 1:2627 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4608
Practice Address - Country:US
Practice Address - Phone:316-684-5300
Practice Address - Fax:316-684-6336
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS619101YA0400X
KS41371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)