Basic Information
| Provider Information | |||||||||
| NPI: | 1730399445 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLDSTEIN | ||||||||
| FirstName: | STACY | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M. A., CCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 114 FORREST AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NARBERTH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190722218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106680864 | ||||||||
| FaxNumber: | 8669025169 | ||||||||
| Practice Location | |||||||||
| Address1: | 114 FORREST AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NARBERTH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190722218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106680864 | ||||||||
| FaxNumber: | 8669025169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SL-007997 | PA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.