MEDICARE: SOUTH MOUNTAIN SPEECH AND FEEDING LLC

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

General Provider Information

NPI Number	:	1598118861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH MOUNTAIN SPEECH AND FEEDING LLC

Provider Business Mailing Address
First Line	:	25 CLINTON AVE
Second Line	:
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-2128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 CLINTON AVE
Second Line	:
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-2128
Country	:	US
Telephone Number	:	973-913-4554
Fax Number	:

Authorized Official
Title or Position	:	SPEECH-LANGUAGE PATHOLOGIST
Name	:	RACHEL GOLDMAN
Credential	:	M.S., CCC-SLP
Telephone Number	:	973-913-4554

Provider Enumeration Date	:	07/21/2016
Last Update Date	:	07/21/2016

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Directions to “SOUTH MOUNTAIN SPEECH AND FEEDING LLC ” Practice Location

Language	Start Address	Practice Location

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