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NPI Code Detail

MEDICARE: STEPHANIE M GODDARD

MEDICARE: STEPHANIE M GODDARD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1922665363
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE M GODDARD
Provider Business Mailing Address
First Line : 621 IOWA AVE APT A
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80909-4787
Country : US
Telephone Number : 716-983-9699
Fax Number :
Provider Business Practice Location Address
First Line : 17230 JACKSON CREEK PKWY STE 220
Second Line :
City : MONUMENT
State : CO
Zip : 80132-7304
Country : US
Telephone Number : 719-597-0822
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2019
Last Update Date : 05/21/2019

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Directions to “ STEPHANIE M GODDARD ” Practice Location

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