Provider Demographics
NPI:1649402744
Name:GOLDSTEIN, MARILYN KAREN
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:KAREN
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WOODSIDE RD
Mailing Address - Street 2:APT. B101
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1861
Mailing Address - Country:US
Mailing Address - Phone:610-645-7733
Mailing Address - Fax:
Practice Address - Street 1:104 WOODSIDE RD
Practice Address - Street 2:APT. B101
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1861
Practice Address - Country:US
Practice Address - Phone:610-645-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-23
Last Update Date:2009-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL002761L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist