Provider Demographics
NPI:1639447790
Name:ELMORE, BETH LYNN (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:LYNN
Last Name:ELMORE
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 1:9835 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-1243
Mailing Address - Country:US
Mailing Address - Phone:314-968-4710
Mailing Address - Fax:314-968-4762
Practice Address - Street 1:9835 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-1243
Practice Address - Country:US
Practice Address - Phone:314-968-4710
Practice Address - Fax:314-968-4762
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist