Provider Demographics
NPI:1598995458
Name:ABISROR, BETH (MA)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:
Last Name:ABISROR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 E 24TH AVE
Mailing Address - Street 2:A
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2208
Mailing Address - Country:US
Mailing Address - Phone:907-929-0890
Mailing Address - Fax:907-929-0890
Practice Address - Street 1:532 E 24TH AVE
Practice Address - Street 2:A
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2208
Practice Address - Country:US
Practice Address - Phone:907-929-0890
Practice Address - Fax:907-929-0890
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK301235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKSLP 35OtherSPEECH-LANGUAGE PATHOLOGIST LICENSE