Provider Demographics
NPI:1184138273
Name:GOLDBERG, SUSAN K
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:GOLDBERG
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 1:12847 PEMBROKE CIR
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-1625
Mailing Address - Country:US
Mailing Address - Phone:913-484-2302
Mailing Address - Fax:
Practice Address - Street 1:12847 PEMBROKE CIR
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-1625
Practice Address - Country:US
Practice Address - Phone:913-484-2302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist