| Doctor Name: | FRED GOLDSTEIN |
| NPI Number: | 1760786065 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.A. CCC-SLP |
| License Number: | 22001315A |
| Business Practice Address: | 1415 Lincolnway W Suite M Osceola, IN - 465612062 |
| Business Phone Number: | 5746757767 |
| Business Fax Number: | |
| Mailing Address: | 657 Ostemo Pl, SOUTH BEND |
| State: | IN |
| Postal Code: | 466171025 |
| Phone Number: | 5742925513 |
| Fax Number: | |
| NPI Enumeration Date: | 12/29/2010 |
| NPI Last Update Date: | 12/29/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 22001315A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |