Nicole Goossen, CF-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2128 Issued in ND

Practice address

1702 E Main St Ste 103
Mandan, ND 58554-3818

Phone

(701) 415-0000

Fax

(833) 969-0195

NPI assigned

Jun 7, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kids in Motion Inc

  • Physical Therapy Clinic/Center
  • Mandan, ND
  • NPI 1649736422
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654560000000",
    "number": "1255060067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 E MAIN ST STE 103",
            "city": "MANDAN",
            "state": "ND",
            "postal_code": "585543818",
            "telephone_number": "701-415-0000",
            "fax_number": "833-969-0195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 E MAIN ST STE 103",
            "city": "MANDAN",
            "state": "ND",
            "postal_code": "585543818",
            "telephone_number": "701-415-0000",
            "fax_number": "833-969-0195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOOSSEN",
        "first_name": "NICOLE",
        "credential": "CF-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-07",
        "last_updated": "2022-06-07",
        "certification_date": "2022-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "ND",
            "license": "2128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jamison William Gray, DC
• Trystan Gregory, SLP
• Faith Gress
• Hannah Gress

• Speech-Language Pathologist in Mandan, ND
• Providers in Mandan, ND by specialty
• Speech-Language Pathologist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.