Provider Demographics
NPI:1730399445
Name:GOLDSTEIN, STACY G (M A, CCC)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:G
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:M A, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 FORREST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-2218
Mailing Address - Country:US
Mailing Address - Phone:610-668-0864
Mailing Address - Fax:866-902-5169
Practice Address - Street 1:114 FORREST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2218
Practice Address - Country:US
Practice Address - Phone:610-668-0864
Practice Address - Fax:866-902-5169
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL-007997235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist