Provider Demographics
NPI:1811034721
Name:GOLDSTEIN, BETH ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANN
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4043 E SOLANO DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-1144
Mailing Address - Country:US
Mailing Address - Phone:480-544-6477
Mailing Address - Fax:602-840-0788
Practice Address - Street 1:4043 E SOLANO DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-1144
Practice Address - Country:US
Practice Address - Phone:480-544-6477
Practice Address - Fax:602-840-0788
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1868235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ703795OtherAZ AHCCCS #
AZSLP1868OtherAZ DEPT OF HEALTH SERVICE