Provider Demographics
NPI:1043422462
Name:CHITTICK ANDERSON, BETH ANN (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:CHITTICK ANDERSON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17942 HOMEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1717
Mailing Address - Country:US
Mailing Address - Phone:219-688-4045
Mailing Address - Fax:708-647-8082
Practice Address - Street 1:17942 HOMEWOOD AVE
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1717
Practice Address - Country:US
Practice Address - Phone:219-688-4045
Practice Address - Fax:708-647-8082
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002592A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist