Provider Demographics
NPI:1710237813
Name:GUHLSTORF, BETH ANN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:GUHLSTORF
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1676 N 1800 EAST RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-7661
Mailing Address - Country:US
Mailing Address - Phone:217-827-4422
Mailing Address - Fax:217-824-1854
Practice Address - Street 1:1676 N 1800 EAST RD
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-7661
Practice Address - Country:US
Practice Address - Phone:217-827-4422
Practice Address - Fax:217-824-1854
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-16
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009407235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist