Provider Demographics
NPI:1073904967
Name:GOLDEN, REISHA (SLP)
Entity Type:Individual
Prefix:
First Name:REISHA
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 ATLANTIC AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2264
Mailing Address - Country:US
Mailing Address - Phone:714-614-1316
Mailing Address - Fax:833-963-1434
Practice Address - Street 1:4401 ATLANTIC AVENUE SUITE 200
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-6015
Practice Address - Country:US
Practice Address - Phone:714-614-1316
Practice Address - Fax:562-318-3050
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23664235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist