1831226612 NPI number — MS. JOANN CAROL GOIFFON M.S., CCC-SLP

Table of content: MS. JOANN CAROL GOIFFON M.S., CCC-SLP (NPI 1831226612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831226612 NPI number — MS. JOANN CAROL GOIFFON M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOIFFON
Provider First Name:
JOANN
Provider Middle Name:
CAROL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831226612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5265 E LAKE BEACH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHOREVIEW
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55126-1381
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-483-0282
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 OSBORNE RD NE
Provider Second Line Business Practice Location Address:
UNITY PROFESSIONAL BUILDING SUITE 310
Provider Business Practice Location Address City Name:
FRIDLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55432-2765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-483-0282
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  5072 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1022810 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 129904 . This is a "U-CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4600192 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 74512 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4600192 . This is a "SELECT CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1120004 . This is a "METROPOLITAN HEALTH PLANS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 23086G0 . This is a "BLUE CROSS-BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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