Provider Demographics
NPI:1780681254
Name:GOFF, FRANCES R (PHD)
Entity Type:Individual
Prefix:
First Name:FRANCES
Middle Name:R
Last Name:GOFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11104 PARKVIEW CIRCLE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1730
Mailing Address - Country:US
Mailing Address - Phone:260-460-3100
Mailing Address - Fax:260-460-3130
Practice Address - Street 1:11104 PARKVIEW CIRCLE DR STE 110
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1730
Practice Address - Country:US
Practice Address - Phone:260-460-3100
Practice Address - Fax:260-460-3130
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040766A103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN680012060OtherRR MEDICARE
IN200263250Medicaid
OH2169317Medicaid
IN5506830003Medicare NSC
IN5506830001Medicare NSC
IN148730CMedicare PIN
IN680012060OtherRR MEDICARE
R33700Medicare UPIN