MEDICARE: BETH CHINERY SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	7452	MN

General Provider Information

NPI Number	:	1871595926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH CHINERY SLP

Provider Business Mailing Address
First Line	:	1608A EUSTIS ST
Second Line	:	#302
City	:	LAUDERDALE
State	:	MN
Zip	:	55108-1253
Country	:	US
Telephone Number	:	651-603-6925
Fax Number	:

Provider Business Practice Location Address
First Line	:	9220 BASS LAKE RD
Second Line	:	SUITE 260
City	:	NEW HOPE
State	:	MN
Zip	:	55428-3000
Country	:	US
Telephone Number	:	763-533-0363
Fax Number	:	763-533-0842

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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Directions to “ BETH CHINERY SLP” Practice Location

Language	Start Address	Practice Location

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