Provider Demographics
NPI:1194005405
Name:MILES, BETH L (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:L
Last Name:MILES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BROOME ST
Mailing Address - Street 2:3E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-1695
Mailing Address - Country:US
Mailing Address - Phone:973-902-2180
Mailing Address - Fax:
Practice Address - Street 1:510 BROOME ST
Practice Address - Street 2:3E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-1695
Practice Address - Country:US
Practice Address - Phone:973-902-2180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018975235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist