Healthcare Provider Details

I. General information

NPI: 1174045595
Provider Name (Legal Business Name): BETH ANN GIDMAN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2731 E BATTLEFIELD RD
SPRINGFIELD MO
65804-3981
US

IV. Provider business mailing address

2731 E BATTLEFIELD RD
SPRINGFIELD MO
65804-3981
US

V. Phone/Fax

Practice location:
  • Phone: 417-397-3200
  • Fax: 417-244-0830
Mailing address:
  • Phone: 417-397-3200
  • Fax: 417-244-0830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2017024442
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: