Provider Demographics
NPI:1568606945
Name:GODELMAN, ANNA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:
Last Name:GODELMAN
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 1:665 BROADWAY FL 9
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2330
Mailing Address - Country:US
Mailing Address - Phone:347-416-1775
Mailing Address - Fax:
Practice Address - Street 1:2108 77TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1341
Practice Address - Country:US
Practice Address - Phone:347-416-1775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58 019851235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist