MEDICARE: STEFANIE GOLDBACH

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	:	1912572538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFANIE GOLDBACH

Provider Business Mailing Address
First Line	:	5671 WINDCROFT DR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-4858
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5671 WINDCROFT DR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-4858
Country	:	US
Telephone Number	:	213-925-0736
Fax Number	:

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

Provider Enumeration Date	:	05/25/2021
Last Update Date	:	05/25/2021

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Directions to “ STEFANIE GOLDBACH ” Practice Location

Language	Start Address	Practice Location

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