Provider Demographics
NPI:1174172225
Name:GODIER, KIERSTIN ELIZABETH (LMSW)
Entity type:Individual
Prefix:
First Name:KIERSTIN
Middle Name:ELIZABETH
Last Name:GODIER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:KINGDOM CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65262-0059
Mailing Address - Country:US
Mailing Address - Phone:573-642-5345
Mailing Address - Fax:573-642-5162
Practice Address - Street 1:8548 JADE ROAD
Practice Address - Street 2:
Practice Address - City:KINGDOM CITY
Practice Address - State:MO
Practice Address - Zip Code:65262-6526
Practice Address - Country:US
Practice Address - Phone:573-642-5345
Practice Address - Fax:573-642-5162
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019033077104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2019033077OtherLMSW LICENSE NUMBER