Healthcare Provider Details

I. General information

NPI: 1578057063
Provider Name (Legal Business Name): LAURA GIVENS GOLDMAN M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14550 OLD SAINT AUGUSTINE RD STE 209
JACKSONVILLE FL
32258-2460
US

IV. Provider business mailing address

2373 CIMARRONE BLVD
SAINT JOHNS FL
32259-1108
US

V. Phone/Fax

Practice location:
  • Phone: 904-271-6000
  • Fax:
Mailing address:
  • Phone: 904-307-4224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA8173
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: