Provider Demographics
NPI:1437377447
Name:CEGAVSKE, BETH (DA)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:CEGAVSKE
Suffix:
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 N COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1603
Mailing Address - Country:US
Mailing Address - Phone:520-327-0882
Mailing Address - Fax:520-327-6205
Practice Address - Street 1:2250 EL MERCADO LOOP
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-5204
Practice Address - Country:US
Practice Address - Phone:520-459-7559
Practice Address - Fax:520-459-7559
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA1692237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter