Provider Demographics
NPI:1003148941
Name:GOLDMAN, LAURA GESSOW (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:GESSOW
Last Name:GOLDMAN
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 1:114 FORREST AVE.
Mailing Address - Street 2:STE. 200
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072
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:STE. 200
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072
Practice Address - Country:US
Practice Address - Phone:610-668-0864
Practice Address - Fax:866-902-5169
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL-001863-L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist