Provider Demographics
NPI:1427575612
Name:SIES, BETH LYNN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:LYNN
Last Name:SIES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:LYNN
Other - Last Name:WAGONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:340 KELLY ST
Mailing Address - Street 2:
Mailing Address - City:GILLESPIE
Mailing Address - State:IL
Mailing Address - Zip Code:62033
Mailing Address - Country:US
Mailing Address - Phone:217-839-4828
Mailing Address - Fax:217-839-3360
Practice Address - Street 1:340 KELLY ST
Practice Address - Street 2:
Practice Address - City:GILLESPIE
Practice Address - State:IL
Practice Address - Zip Code:62033
Practice Address - Country:US
Practice Address - Phone:217-839-4828
Practice Address - Fax:217-839-3360
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist