Kelly Marie Goodwin

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-18-31541 Issued in IL

Practice address

2990 N Perryville Rd
Rockford, IL 61107-6814

Phone

(815) 469-1500

NPI assigned

Oct 11, 2018

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

Other names 1

• Kelly Marie Lough Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Westside Childrens Therapy

  • Physical Therapist
  • Joliet, IL
  • NPI 1972783900
  NPD (past)

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

{
    "created_epoch": "1539216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657584000000",
    "number": "1972078392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2990 N PERRYVILLE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611076814",
            "telephone_number": "815-469-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2990 N PERRYVILLE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611076814",
            "telephone_number": "815-469-1500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9500 Bormet Dr Ste 201",
            "address_purpose": "LOCATION",
            "city": "Mokena",
            "state": "IL",
            "postal_code": "604488399",
            "country_code": "US",
            "telephone_number": "815-469-1500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOODWIN",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-11",
        "last_updated": "2022-07-12",
        "certification_date": "2022-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "IL",
            "license": "1-18-31541",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "LOUGH",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Edwin Gonzalez Montoya, OMFS
• Alejandro Gonzalez, MS
• Jacqueline Gonzalez
• Nicole Gonzalez
• Good Old Home Care Services
• Grace Gordon, PA-C
• Linda Louise Gossett, RN, BSN
• Kavitha Gowda, D.D.S.
• Ruby Lanelle Gowdy
• Vijay K Goyal, M.D.

• Behavior Analyst in Rockford, IL
• Providers in Rockford, IL by specialty
• Behavior Analyst in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2022; 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.