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Staci Lyn Gofton

Social Worker

Behavioral Health & Social Service Providers

PECOS Enrollment

This provider is enrolled in PECOS as STACI GOFTON.

Based on the most recent information from CMS, provider Staci Lyn Gofton is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1770654360
Provider Type
Individual
Full Name
Gofton, Staci Lyn
Title
Miss
Credential
LMSW

Gender
Female
Sole Proprietor
Yes
Enumeration Date
11/13/2006
Last Updated
7/8/2007

Contact Information

Practice Location

3285 122nd Ave, Allegan, MI 49010-9511

(269) 673-6617

(269) 673-2738

Mailing Location

560 Parkside Ave NW, Grand Rapids, MI 49534-3411

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 6801085687 Michigan

Staci Lyn Gofton

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Sparks, Kenneth John

Redman, Charles B

Heinonen, Dennis Frank

Todaro, Lauren

Plummer, Sarah

Higgs, Emma

Zwaanstra, Janice Marie

Hoekstra, Patrick

Schuyler, Alison Kay

Grace, Gabrielle