MEDICARE: MRS. BETH ANNA DEITER M.A. CCC-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	146.008208	IL

General Provider Information

NPI Number	:	1942345285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETH ANNA DEITER M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	2016 E SAINT JAMES ST
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-6461
Country	:	US
Telephone Number	:	224-409-7150
Fax Number	:

Provider Business Practice Location Address
First Line	:	2016 E SAINT JAMES ST
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-6461
Country	:	US
Telephone Number	:	224-409-7150
Fax Number	:

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	09/15/2017

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