Provider Demographics
NPI:1205176229
Name:NIEMERG, BETH ANN (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:NIEMERG
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9998 N EFFINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:WHEELER
Mailing Address - State:IL
Mailing Address - Zip Code:62479-2516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9998 N EFFINGHAM ST
Practice Address - Street 2:
Practice Address - City:WHEELER
Practice Address - State:IL
Practice Address - Zip Code:62479-2516
Practice Address - Country:US
Practice Address - Phone:217-925-5580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.001244235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist