Provider Demographics
NPI:1669791562
Name:GOODSTADT, JANA ROSENBLOOM (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JANA
Middle Name:ROSENBLOOM
Last Name:GOODSTADT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2010A DUFOUR AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-1310
Mailing Address - Country:US
Mailing Address - Phone:310-750-5799
Mailing Address - Fax:
Practice Address - Street 1:2010A DUFOUR AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-1310
Practice Address - Country:US
Practice Address - Phone:310-750-5799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15469235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist