Provider Demographics
NPI:1891063111
Name:SEIDER, MARY BETH (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BETH
Last Name:SEIDER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9175 DUNN RD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:NY
Mailing Address - Zip Code:14025-9759
Mailing Address - Country:US
Mailing Address - Phone:716-941-6758
Mailing Address - Fax:
Practice Address - Street 1:11720 PARTRIDGE RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:NY
Practice Address - Zip Code:14080-9800
Practice Address - Country:US
Practice Address - Phone:716-537-8275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006999-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist