MEDICARE: MS. PAULETTE GOLDSTEIN MS., CCC-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	SP-910	NV

General Provider Information

NPI Number	:	1477881837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAULETTE GOLDSTEIN MS., CCC-SLP

Provider Business Mailing Address
First Line	:	1489 W. WARMSPRINGS ROAD
Second Line	:	DAVINCI EXECUTIVE SUITES
City	:	HENDERSON
State	:	NV
Zip	:	89014
Country	:	US
Telephone Number	:	702-277-0847
Fax Number	:

Provider Business Practice Location Address
First Line	:	1489 W WARM SPRINGS RD
Second Line	:	110
City	:	HENDERSON
State	:	NV
Zip	:	89014-7635
Country	:	US
Telephone Number	:	702-277-0847
Fax Number	:

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

Provider Enumeration Date	:	11/24/2009
Last Update Date	:	11/24/2009

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