Provider Demographics
NPI:1780935999
Name:BORRETT, BETH LOUISE (SLP)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:LOUISE
Last Name:BORRETT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 NE 43RD CT
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-4915
Mailing Address - Country:US
Mailing Address - Phone:515-402-8980
Mailing Address - Fax:
Practice Address - Street 1:708 S JEFFERSON WAY
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-3216
Practice Address - Country:US
Practice Address - Phone:515-962-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001829235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist