Provider Demographics
NPI:1033652854
Name:GOLDVEKHT, SVETLANA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:GOLDVEKHT
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 1:9805 63RD RD APT 10K
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1722
Mailing Address - Country:US
Mailing Address - Phone:718-316-7320
Mailing Address - Fax:
Practice Address - Street 1:3309 35TH AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-1220
Practice Address - Country:US
Practice Address - Phone:718-786-6703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist