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General NPI Number Information
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NPI Number | 1730693938
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Entity Type | Individual
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Provider Name | MARY BETH HIGH MS SLP
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Gender | Female
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Dates
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Enumeration Date | 11/27/2017
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Last Update Date | 11/27/2017
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Provider Practice Location Address
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Address Line | 620 E GARFIELD AVE
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City | DECATUR
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State | IL
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Zip | 62526-4550
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Country | US
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Telephone | 217-362-3360
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Fax |
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Provider Business Mailing Address
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Address Line | 4 MORNING GLORY CT
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City | MT ZION
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State | IL
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Zip | 62549-9705
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Country | US
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Telephone | 217-855-7571
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146001174
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License Number State | IL
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