Provider Demographics
NPI:1366798456
Name:GOLDSTEIN, ALLISON BROOKE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:BROOKE
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 FORMAX DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-9328
Mailing Address - Country:US
Mailing Address - Phone:561-271-3873
Mailing Address - Fax:
Practice Address - Street 1:7950 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8229
Practice Address - Country:US
Practice Address - Phone:407-658-2046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 11641235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist