Healthcare Provider Details

I. General information

NPI: 1750511689
Provider Name (Legal Business Name): BETH THOMAS HAAS MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 AMERICAN LEGION LN
PINEHURST NC
28374-8978
US

IV. Provider business mailing address

PO BOX 4177
PINEHURST NC
28374-4177
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-2609
  • Fax: 910-295-0026
Mailing address:
  • Phone: 910-295-2609
  • Fax: 910-295-0026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5706
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: