Provider Demographics
NPI:1508359407
Name:GOLDBERG, YEHUDIS C (SLP)
Entity Type:Individual
Prefix:MRS
First Name:YEHUDIS
Middle Name:C
Last Name:GOLDBERG
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 1:1388 PASADENA ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3921
Mailing Address - Country:US
Mailing Address - Phone:732-364-1534
Mailing Address - Fax:
Practice Address - Street 1:1388 PASADENA ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3921
Practice Address - Country:US
Practice Address - Phone:732-364-1534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00572900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist