MEDICARE: MS. ALYSSA LARSEN GOLDENBERG MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP12690	AZ

General Provider Information

NPI Number	:	1053918490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALYSSA LARSEN GOLDENBERG MS, CCC-SLP

Provider Business Mailing Address
First Line	:	4350 E RAY RD BLDG 1
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-4703
Country	:	US
Telephone Number	:	480-704-5954
Fax Number	:	480-704-5807

Provider Business Practice Location Address
First Line	:	4350 E RAY RD BLDG 1
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-4703
Country	:	US
Telephone Number	:	480-704-5954
Fax Number	:	480-704-5807

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2020
Last Update Date	:	12/09/2025

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