Provider Demographics
NPI:1831413699
Name:GOLDFIELD, STACY ROSE (SPA)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ROSE
Last Name:GOLDFIELD
Suffix:
Gender:F
Credentials:SPA
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:ROSE
Other - Last Name:PICKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SPA
Mailing Address - Street 1:1120 VIA CALLEJON STE B
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6264
Mailing Address - Country:US
Mailing Address - Phone:949-498-5100
Mailing Address - Fax:
Practice Address - Street 1:1120 VIA CALLEJON STE B
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6264
Practice Address - Country:US
Practice Address - Phone:949-498-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA 8412355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant