Provider Demographics
NPI:1053601245
Name:GOODSON, DAVID WAYNE (MSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WAYNE
Last Name:GOODSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E 4TH ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-5798
Mailing Address - Country:US
Mailing Address - Phone:319-234-7600
Mailing Address - Fax:319-236-3825
Practice Address - Street 1:500 E 4TH ST
Practice Address - Street 2:SUITE 410
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-5798
Practice Address - Country:US
Practice Address - Phone:319-234-7600
Practice Address - Fax:319-236-3825
Is Sole Proprietor?:No
Enumeration Date:2011-04-09
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker