Provider Demographics
NPI:1528203221
Name:WOLCOTT, BETH ANNE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANNE
Last Name:WOLCOTT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:NY
Mailing Address - Zip Code:14510-1036
Mailing Address - Country:US
Mailing Address - Phone:585-658-2828
Mailing Address - Fax:585-658-4109
Practice Address - Street 1:1 COLLEGE CIR
Practice Address - Street 2:SUNY GENESEO-HOLCOMB BUILDING
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1401
Practice Address - Country:US
Practice Address - Phone:585-245-5688
Practice Address - Fax:585-245-5685
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015686-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist