Provider Demographics
NPI:1588730543
Name:GOODMAN, SUSAN LEANNA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LEANNA
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:LEANNA
Other - Last Name:TANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:63 ROBBERS ROOST LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-3524
Mailing Address - Country:US
Mailing Address - Phone:435-586-0470
Mailing Address - Fax:
Practice Address - Street 1:2202 N MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-9765
Practice Address - Country:US
Practice Address - Phone:435-586-4479
Practice Address - Fax:435-865-0023
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT341436-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical