Provider Demographics
NPI:1205603867
Name:GORMLEY, BETH ANNE (MA)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANNE
Last Name:GORMLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9200
Mailing Address - Country:US
Mailing Address - Phone:719-488-4700
Mailing Address - Fax:719-785-4218
Practice Address - Street 1:115 UPPER GLENWAY
Practice Address - Street 2:
Practice Address - City:PALMER LAKE
Practice Address - State:CO
Practice Address - Zip Code:80133-5147
Practice Address - Country:US
Practice Address - Phone:719-488-4760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO284725235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist