Provider Demographics
NPI:1669759189
Name:LADD, BETH
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:LADD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 CAHUENGA BLVD W APT 311
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-1584
Mailing Address - Country:US
Mailing Address - Phone:615-310-2359
Mailing Address - Fax:
Practice Address - Street 1:3400 CAHUENGA BLVD W APT 311
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1584
Practice Address - Country:US
Practice Address - Phone:615-310-2359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18660235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist