Provider Demographics
NPI:1508565458
Name:TETELBAUM, BETH S (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:S
Last Name:TETELBAUM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20100 W COUNTRY CLUB DR APT 1009
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1634
Mailing Address - Country:US
Mailing Address - Phone:954-296-3175
Mailing Address - Fax:
Practice Address - Street 1:20100 W COUNTRY CLUB DR APT 1009
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1634
Practice Address - Country:US
Practice Address - Phone:954-296-3175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20184235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist