Provider Demographics
NPI:1356469126
Name:DAUGHERTY, BETH RAE (MS CF SLP)
Entity Type:Individual
Prefix:MISS
First Name:BETH
Middle Name:RAE
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:MS CF SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5642 BAYWATER DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3501
Mailing Address - Country:US
Mailing Address - Phone:407-488-2993
Mailing Address - Fax:
Practice Address - Street 1:7380 ULMERTON RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-4512
Practice Address - Country:US
Practice Address - Phone:727-330-9750
Practice Address - Fax:727-524-8724
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ4145235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist