Provider Demographics
NPI:1356488746
Name:GOLDMAN, REBECCA S M (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:S M
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 1:9558 INDIAN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132-2138
Mailing Address - Country:US
Mailing Address - Phone:314-229-2560
Mailing Address - Fax:
Practice Address - Street 1:9558 INDIAN MEADOWS DR
Practice Address - Street 2:
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-2138
Practice Address - Country:US
Practice Address - Phone:314-229-2560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999142852235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist