Healthcare Provider Details

I. General information

NPI: 1023056421
Provider Name (Legal Business Name): MICHAL Y GOLDSTEIN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 CHARTRES ST
LA SALLE IL
61301-1097
US

IV. Provider business mailing address

144 N 2551ST RD
PERU IL
61354-9459
US

V. Phone/Fax

Practice location:
  • Phone: 815-223-9678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: