Provider Demographics
NPI:1568744357
Name:GALL, BETH ANN
Entity Type:Individual
Prefix:
First Name:BETH ANN
Middle Name:
Last Name:GALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2578 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:RETSOF
Mailing Address - State:NY
Mailing Address - Zip Code:14539
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2578 GENESEE ST
Practice Address - Street 2:
Practice Address - City:RETSOF
Practice Address - State:NY
Practice Address - Zip Code:14539
Practice Address - Country:US
Practice Address - Phone:585-243-1730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010743-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist