Goodwill Industries of North Central Wisconsin Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

GOODWILL INDUSTRIES OF NORTH CENTRAL WISCONSIN INC

Doing business as

Early Intervention Services

Practice address

1800 Appleton Road
Menasha, WI 54952

Phone

(920) 731-6601

Fax

(920) 968-6977

NPI assigned

Nov 28, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stephen A White

Title

Cfo

Phone

(920) 731-6601

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Early Intervention Services Doing business as

Tax ID family

Beyond Boundaries of Autison2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Goodwill Industries of North Central Wi

  dba Beyond Boundaries of Autison

  • Psychologist
  • Menasha, WI
  • NPI 1376647388
  NPD tax ID

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649346990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 APPLETON ROAD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "54952",
            "telephone_number": "920-731-6601",
            "fax_number": "920-968-6977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 APPLETON ROAD",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "54952",
            "telephone_number": "920-731-6601",
            "fax_number": "920-968-6977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOODWILL INDUSTRIES OF NORTH CENTRAL WISCONSIN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "920-731-6601"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41215200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Early Intervention Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ann M Gierl, DO
• Yvette Samantha Goebel, PH.D
• Gold Cross Ambulance Service Inc
• Jill M Goldstein, CSAC
• Goodwill Industries of North Central Wi (Beyond Boundaries of Autison)
• Nicholas A Goranson, COTA
• Sarah Ann Goranson, MS, OTR
• Danielle Grall
• Catherine Gray
• Keri Gretebeck, LPC-IT

• Clinic/Center in Menasha, WI
• Providers in Menasha, WI by specialty
• Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.