Provider Demographics
NPI:1619957800
Name:MCSWEENEY, BETH-ANN GRIESSER (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BETH-ANN
Middle Name:GRIESSER
Last Name:MCSWEENEY
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:MRS
Other - First Name:BETH-ANN
Other - Middle Name:GRIESSER
Other - Last Name:RAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CCC-SLP
Mailing Address - Street 1:2529 KINGS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HAYES
Mailing Address - State:VA
Mailing Address - Zip Code:23072-4325
Mailing Address - Country:US
Mailing Address - Phone:678-595-5558
Mailing Address - Fax:
Practice Address - Street 1:6425 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-7202
Practice Address - Country:US
Practice Address - Phone:757-585-7176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7657235Z00000X
VA2202006889235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS9150OtherBCBS
FL8901597-00Medicaid