Provider Demographics
NPI:1992188692
Name:MOORHEAD, BETH NICOLE
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:NICOLE
Last Name:MOORHEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:NICOLE
Other - Last Name:HERINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2676 US HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:KY
Mailing Address - Zip Code:41040-8555
Mailing Address - Country:US
Mailing Address - Phone:859-462-7455
Mailing Address - Fax:
Practice Address - Street 1:2676 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:KY
Practice Address - Zip Code:41040-8555
Practice Address - Country:US
Practice Address - Phone:859-462-7455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist