Provider Demographics
NPI:1770386559
Name:GODKIN, JULIANNE LARA (LCSW)
Entity type:Individual
Prefix:
First Name:JULIANNE
Middle Name:LARA
Last Name:GODKIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21753 W HALIFAX DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-6033
Mailing Address - Country:US
Mailing Address - Phone:815-690-3226
Mailing Address - Fax:
Practice Address - Street 1:13717 S ROUTE 30 STE 159
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-5561
Practice Address - Country:US
Practice Address - Phone:630-580-8281
Practice Address - Fax:815-577-2785
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0291201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical