Provider Demographics
NPI:1487779146
Name:GOLDSBOROUGH, JODY (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:GOLDSBOROUGH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 SUFFOLK RD
Mailing Address - Street 2:
Mailing Address - City:RYDAL
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3426
Mailing Address - Country:US
Mailing Address - Phone:215-885-7103
Mailing Address - Fax:
Practice Address - Street 1:756 SUFFOLK RD
Practice Address - Street 2:
Practice Address - City:RYDAL
Practice Address - State:PA
Practice Address - Zip Code:19046-3426
Practice Address - Country:US
Practice Address - Phone:215-885-7103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL00001479L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist