Provider Demographics
NPI:1699829002
Name:STONE, BETH VALERIE (MA)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:VALERIE
Last Name:STONE
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 1:2505 L ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-4215
Mailing Address - Country:US
Mailing Address - Phone:707-268-8245
Mailing Address - Fax:707-443-9678
Practice Address - Street 1:2505 L ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4215
Practice Address - Country:US
Practice Address - Phone:707-268-8245
Practice Address - Fax:707-443-9678
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 3562235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP0035620Medicaid