Provider Demographics
NPI:1043072911
Name:LEGG, BETH (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:LEGG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:RUARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1350 DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3312
Mailing Address - Country:US
Mailing Address - Phone:509-552-1925
Mailing Address - Fax:
Practice Address - Street 1:820 MAIN ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-8014
Practice Address - Country:US
Practice Address - Phone:303-702-7806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist