Provider Demographics
NPI:1407139108
Name:WAITE, BETH A (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:A
Last Name:WAITE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9106 N MERIDIAN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1881
Mailing Address - Country:US
Mailing Address - Phone:317-575-9111
Mailing Address - Fax:317-571-4470
Practice Address - Street 1:9106 N MERIDIAN ST STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1881
Practice Address - Country:US
Practice Address - Phone:317-575-9111
Practice Address - Fax:317-571-4470
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001696A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist