Provider Demographics
NPI:1730351495
Name:GODWIN, SARAH JAYNE (LMHC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JAYNE
Last Name:GODWIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:J
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1441 W CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-1707
Mailing Address - Country:US
Mailing Address - Phone:563-888-6275
Mailing Address - Fax:563-884-4638
Practice Address - Street 1:1441 W CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-1707
Practice Address - Country:US
Practice Address - Phone:563-888-6275
Practice Address - Fax:563-884-4638
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001419101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health