Provider Demographics
NPI:1548741044
Name:GOLDSTEIN, SHIRA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHIRA
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5669 N NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-6153
Mailing Address - Country:US
Mailing Address - Phone:773-467-5669
Mailing Address - Fax:
Practice Address - Street 1:5669 N NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-6153
Practice Address - Country:US
Practice Address - Phone:773-467-5669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.004927235Z00000X
IL146.014866235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist