Provider Demographics
NPI:1578970984
Name:GOLDBERG, DANA KATHRINS (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:KATHRINS
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:ALEXIS
Other - Last Name:KATHRINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12417 BOBBINK CT
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3005
Mailing Address - Country:US
Mailing Address - Phone:908-783-3843
Mailing Address - Fax:
Practice Address - Street 1:12417 BOBBINK CT
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3005
Practice Address - Country:US
Practice Address - Phone:908-783-3843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07319235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist