MRS. STACEY P GOODMAN (NPI# 1568639490) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568639490 |
| Entity Type | Individual |
| Full Name | MRS. STACEY P GOODMAN |
| Credential | COTA |
| Practice Address |
926 E Wayne St South Bend IN 46617-3000 |
| Mailing Address |
10379 Edison Rd Osceola IN 46561-9355 |
| Practice Telephone | 5742338812 |
| Practice Fax Number | 5742338873 |
| Mailing Telephone | 5746740575 |
| Mailing Fax Number | 5746740575 |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2008-05-09 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 32000767A | IN | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417258963 | Stacey Michelle Goodman | Nurse Practitioner | 1135 W University Dr, Suite 425, Rochester, MI 48307-1871 | 2010-11-15 |
| 1639278062 | Stacey Goodman | Internal Medicine | 3601 Tvc, Nashville, TN 37232-0001 | 2006-09-22 |
| Street Address |
926 E WAYNE ST |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46617-3000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447439625 | Christopher J Hipsher | Occupational Therapy Assistant | 926 E Wayne St, South Bend, IN 46617-3000 | 2007-10-24 |
| 1124434410 | Kristen Konecny | Occupational Therapy Assistant | 926 E Wayne St, South Bend, IN 46617-3000 | 2014-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740731116 | Jack Mcintyre Kimmell | Specialist/Technologist | 1526 East Lasalle, South Bend, IN 46617 | 2016-10-20 |
| 1023429115 | Morning View Assisted Living LLC | Assisted Living Facility | 475 N. Niles Avenue, South Bend, IN 46617 | 2014-05-12 |
| 1265861231 | Rebecca Busenbark | Physical Therapist | 401 E Colfax Ave Ste 102, South Bend, IN 46617 | 2013-11-11 |
| 1962709071 | Doreen Danice Huddleston | Social Worker | 928 East Wayne St, Suit C, South Bend, IN 46617 | 2011-02-25 |
| 1487981734 | Mary Cecilia Roemer | Marriage & Family Therapist | 616 E. Colfax Ave, South Bend, IN 46617 | 2009-11-06 |
| 1225264054 | Sridhar Meda | Dentist | 1005 East Lasalle Ave, South Bend, IN 46617 | 2009-06-08 |
| 1063673531 | Madeline Christina Watkins | Counselor | 616 E Colfax, South Bend, IN 46617 | 2008-06-18 |
| 1437366481 | Michael Reed Johns | Dentist | 103 South Eddy Street, South Bend, IN 46617 | 2007-05-17 |
| 1194937680 | Sarah Elizabeth Redman | Specialist/Technologist | 53880 Carmichael Dr., South Bend, IN 46617 | 2007-05-04 |
| 1124241211 | Trixy Franke | Family Medicine | 837 E. Cedar St., Ste 100, South Bend, IN 46617 | 2007-04-10 |
| Find all providers in zip 46617 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871922799 | Northern Indiana Orthopaedic Specialty Associates, PC | Specialist | 6301 University Commons Ste 420, South Bend, IN 46635-1416 | 2013-11-01 |
| 1962642306 | Lisa James | Specialist | 60660 Gentle Run Ct, South Bend, IN 46614-5185 | 2009-02-25 |
| 1497928055 | Amy Dennise Woodard | Specialist | 606 Robert Bush Drive, Suite 1, South Bend, WA 98586-0384 | 2008-04-03 |
| 1497842033 | Worksport Rehabilitation Service | Specialist | 411 E Ireland Rd Ste 400, South Bend, IN 46614-2681 | 2006-10-06 |
| 1104834670 | Renee L Hensley | Specialist | 411 E Ireland Rd, Ste 400, South Bend, IN 46614-2680 | 2006-08-03 |
| 1649225095 | Allied Hematology Oncology Associates LLC | Specialist | 6319 State Road 23, South Bend, IN 46635-1475 | 2006-05-24 |
| 1528013372 | Uthman Cavallo | Specialist | 53800 Generations Dr, South Bend, IN 46635 | 2006-05-23 |
| 1578547402 | Ismail Al-ani | Specialist | 621 Memorial Drive, Suite512, South Bend, IN 46601-1074 | 2005-12-05 |
| 1003818212 | John L Jenkins | Specialist | 621 Memorial Dr, Ste 502, South Bend, IN 46601-1075 | 2005-06-01 |
| 1205473451 | Integrative Care Partners LLC | Specialist | 211 N Eddy St, South Bend, IN 46617-2808 | 2019-12-06 |
| Find all providers in SOUTH BEND | ||||
| City | SOUTH BEND |
| Zip Code | 46617 |
Please comment or provide details below to improve the information on MRS. STACEY P GOODMAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.