Active NPI
Priscilla Anne Goodwin, PROF. FOSTER HOME
- Counselor
- Mesa, AZ
National Provider Identifier
1669528949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 5102
- Practice address
- 1710 S 74TH St
Mesa, AZ 85209-4136 - Phone
- (480) 981-5555
- NPI assigned
- Jan 26, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 5102 | AZ | Primary |
Addresses
Primary practice location
1710 S 74TH St
Mesa, AZ 85209-4136
Mailing address
1710 S 74TH St
Mesa, AZ 85209-4136
Phone (480) 981-5555
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5102 | Other | AZ | PROF. FOSTER HOME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5102 | AZ | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236556800000",
"number": "1669528949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1710 S 74TH ST",
"city": "MESA",
"state": "AZ",
"postal_code": "852094136",
"telephone_number": "480-981-5555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1710 S 74TH ST",
"city": "MESA",
"state": "AZ",
"postal_code": "852094136",
"telephone_number": "480-981-5555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODWIN",
"first_name": "PRISCILLA",
"middle_name": "ANNE",
"credential": "PROF. FOSTER HOME",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-26",
"last_updated": "2009-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "AZ",
"license": "5102",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROF. FOSTER HOME",
"identifier": "5102",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.