Provider Demographics
NPI:1659598985
Name:GOLDBERG, SARA ANN (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ANN
Last Name:GOLDBERG
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 1:1905 N 55TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3937
Mailing Address - Country:US
Mailing Address - Phone:954-591-2610
Mailing Address - Fax:954-989-8298
Practice Address - Street 1:1905 N 55TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3937
Practice Address - Country:US
Practice Address - Phone:954-591-2610
Practice Address - Fax:954-989-8298
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1575235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA1575OtherLICENSE FOR FLORIDA