Provider Demographics
NPI:1497945463
Name:GOLDSTEIN, MICHELE GLAZER (MS)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:GLAZER
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RED LION AND KNIGHTS ROADS
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1438
Mailing Address - Country:US
Mailing Address - Phone:215-612-5687
Mailing Address - Fax:213-612-4584
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:DEPARTMENT OF AUDIOLOGY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-612-5687
Practice Address - Fax:213-612-4584
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000773L237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter