Provider Demographics
NPI:1033255716
Name:GOODMAN-ROTHLEIN, LAURIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:GOODMAN-ROTHLEIN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:ROTHLEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:9975 SEACREST CIR APT 202
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3831
Mailing Address - Country:US
Mailing Address - Phone:631-897-5818
Mailing Address - Fax:
Practice Address - Street 1:9975 SEACREST CIR APT 202
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3831
Practice Address - Country:US
Practice Address - Phone:631-897-5818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12351235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist