Provider Demographics
NPI:1730322397
Name:GOLDMAN, CLIFFORD
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4527 NE SKIDMORE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-1758
Mailing Address - Country:US
Mailing Address - Phone:503-282-1150
Mailing Address - Fax:503-282-3637
Practice Address - Street 1:4527 NE SKIDMORE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-1758
Practice Address - Country:US
Practice Address - Phone:503-282-1150
Practice Address - Fax:503-282-3637
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10157235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist