MEDICARE: CRISTIE GOOD 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	SL011762	PA

General Provider Information

NPI Number	:	1558753459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTIE GOOD SLP

Provider Business Mailing Address
First Line	:	21 OLD TIMBER TRL
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15238-2113
Country	:	US
Telephone Number	:	412-251-6576
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 OLD TIMBER TRL
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15238-2113
Country	:	US
Telephone Number	:	412-251-6576
Fax Number	:

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

Provider Enumeration Date	:	03/02/2015
Last Update Date	:	03/02/2015

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Directions to “ CRISTIE GOOD SLP” Practice Location

Language	Start Address	Practice Location

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