Provider Demographics
NPI:1699810499
Name:GOTTLIEB, LINDA HAAS (SLP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:HAAS
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-1331
Mailing Address - Country:US
Mailing Address - Phone:203-387-1779
Mailing Address - Fax:
Practice Address - Street 1:15 JUNE ST
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2238
Practice Address - Country:US
Practice Address - Phone:203-387-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000755235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT660000755CT02OtherINSURANCE PROVIDER NUMBER