Healthcare Provider Details

I. General information

NPI: 1780681254
Provider Name (Legal Business Name): FRANCES R. GOFF PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11104 PARKVIEW CIRCLE DR STE 110
FORT WAYNE IN
46845-1730
US

IV. Provider business mailing address

11104 PARKVIEW CIRCLE DR STE 110
FORT WAYNE IN
46845-1730
US

V. Phone/Fax

Practice location:
  • Phone: 260-460-3100
  • Fax: 260-460-3130
Mailing address:
  • Phone: 260-460-3100
  • Fax: 260-460-3130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20040766A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number20040766A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: