Provider Demographics
NPI:1396119350
Name:GOODS, STEPHANIE (BS, CADC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GOODS
Suffix:
Gender:F
Credentials:BS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2618
Mailing Address - Country:US
Mailing Address - Phone:515-661-0087
Mailing Address - Fax:515-381-3001
Practice Address - Street 1:100 E EUCLID AVE
Practice Address - Street 2:SUITE 157
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50313-4511
Practice Address - Country:US
Practice Address - Phone:515-381-3001
Practice Address - Fax:515-381-3001
Is Sole Proprietor?:No
Enumeration Date:2015-11-13
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14031101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)