Provider Demographics
NPI:1013585926
Name:HUMMELDORF, BETH ANNE (HIS)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANNE
Last Name:HUMMELDORF
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8780 US HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-6936
Mailing Address - Country:US
Mailing Address - Phone:859-384-0333
Mailing Address - Fax:859-384-0444
Practice Address - Street 1:140 W PIKE ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-2310
Practice Address - Country:US
Practice Address - Phone:859-384-0333
Practice Address - Fax:859-384-0444
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101312237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist