Provider Demographics
NPI:1114609294
Name:MCBETH, ALEXIS (MA, SLP)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:MCBETH
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3460 BRIGADOON CIR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44618-9514
Mailing Address - Country:US
Mailing Address - Phone:330-988-4552
Mailing Address - Fax:
Practice Address - Street 1:6057 STRIP AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-9207
Practice Address - Country:US
Practice Address - Phone:330-492-8136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20232392-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist