Provider Demographics
NPI:1386782605
Name:GOLDENBERG, JEAN (MA CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:
Last Name:GOLDENBERG
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:DEITSCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17610 NE 7 PL
Mailing Address - Street 2:
Mailing Address - City:NMB
Mailing Address - State:FL
Mailing Address - Zip Code:33162
Mailing Address - Country:US
Mailing Address - Phone:305-653-5637
Mailing Address - Fax:305-653-5637
Practice Address - Street 1:7425 SW 42 ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155
Practice Address - Country:US
Practice Address - Phone:305-262-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA488235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist