Healthcare Provider Details

I. General information

NPI: 1295642411
Provider Name (Legal Business Name): DANIELLE GOLDBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 VICTORY LN
LIBERTY MO
64068-1920
US

IV. Provider business mailing address

900 FERNWAY LN
CREVE COEUR MO
63141-6144
US

V. Phone/Fax

Practice location:
  • Phone: 816-763-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: