Provider Demographics
NPI:1053552406
Name:GOLDSTEIN, KRISTIN M (MA, CCC-SLP, PC)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:M
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MA, CCC-SLP, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:101 JACKSON AVE
Mailing Address - Street 2:APARTMENT 2B
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2702
Mailing Address - Country:US
Mailing Address - Phone:516-721-1055
Mailing Address - Fax:
Practice Address - Street 1:101 JACKSON AVE
Practice Address - Street 2:APARTMENT 2B
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2702
Practice Address - Country:US
Practice Address - Phone:516-721-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017449-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist