Provider Demographics
NPI:1528201928
Name:GOLDBERG, ROBIN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:
Last Name:GOLDBERG
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 1:1914 SW VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-9401
Mailing Address - Country:US
Mailing Address - Phone:914-450-0886
Mailing Address - Fax:
Practice Address - Street 1:1914 SW VERMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-9401
Practice Address - Country:US
Practice Address - Phone:914-450-0886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005522235Z00000X
NY020875235Z00000X
OR15756235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist