Provider Demographics
NPI:1184862054
Name:MARSH, BETH L (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:L
Last Name:MARSH
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BROOKSIDE AVE E
Mailing Address - Street 2:
Mailing Address - City:APALACHIN
Mailing Address - State:NY
Mailing Address - Zip Code:13732-4139
Mailing Address - Country:US
Mailing Address - Phone:607-765-3103
Mailing Address - Fax:
Practice Address - Street 1:24 BROOKSIDE AVE E
Practice Address - Street 2:
Practice Address - City:APALACHIN
Practice Address - State:NY
Practice Address - Zip Code:13732-4139
Practice Address - Country:US
Practice Address - Phone:607-765-3103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0114531235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist