Doctor Name: | MS. ELISE SUE GOODMAN |
NPI Number: | 1962524165 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. CCC |
License Number: | 3171 |
Business Practice Address: | 977 Main St Waltham, MA - 024517406 |
Business Phone Number: | 7818910452 |
Business Fax Number: | |
Mailing Address: | 26 Jyra Ln, NORTH EASTON |
State: | MA |
Postal Code: | 023562738 |
Phone Number: | 5082386870 |
Fax Number: | |
NPI Enumeration Date: | 04/06/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 3171 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
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 |