Provider Demographics
NPI:1255565461
Name:GOLDBLATT, JUDITH A (MSCCC/SLP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:GOLDBLATT
Suffix:
Gender:F
Credentials:MSCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7517 WEEPING WILLOW BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34241-6421
Mailing Address - Country:US
Mailing Address - Phone:941-379-2725
Mailing Address - Fax:
Practice Address - Street 1:63 SARASOTA CENTER BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-9385
Practice Address - Country:US
Practice Address - Phone:941-379-3725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 12535235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist