Healthcare Provider Details

I. General information

NPI: 1922731421
Provider Name (Legal Business Name): SHULAMIS DEVORAH GOLDSTEIN M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2022
Last Update Date: 07/03/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ALCHARIZI 30 APARTMENT 3
JERUSALEM ISRAEL
9232130
IL

IV. Provider business mailing address

7741 GANNON AVE
UNIVERSITY CITY MO
63130-2822
US

V. Phone/Fax

Practice location:
  • Phone: 314-338-5506
  • Fax:
Mailing address:
  • Phone: 314-229-6051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number28233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: