Provider Demographics
NPI:1568661007
Name:GOLDSBERRY, AMY SUE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SUE
Last Name:GOLDSBERRY
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 1:1422 OAKWOOD HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-2200
Mailing Address - Country:US
Mailing Address - Phone:732-557-4663
Mailing Address - Fax:
Practice Address - Street 1:1579 OLD FREEHOLD RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-2173
Practice Address - Country:US
Practice Address - Phone:908-433-1814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-14
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYS02182235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist