Provider Demographics
NPI:1871552992
Name:GOODISON, JANICE MARY (LCSW)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:MARY
Last Name:GOODISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:
Other - Last Name:MCCAFFREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6563 SKY HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-3097
Mailing Address - Country:US
Mailing Address - Phone:406-499-2709
Mailing Address - Fax:
Practice Address - Street 1:6563 SKY HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-3097
Practice Address - Country:US
Practice Address - Phone:406-499-2709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5171789-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker