Provider Demographics
NPI:1285944090
Name:DAVIDOFF, BETH ELLEN (PHD, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ELLEN
Last Name:DAVIDOFF
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ELLEN
Other - Last Name:BREAKSTONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, MED, CCC-SLP
Mailing Address - Street 1:9 ASHTON LN
Mailing Address - Street 2:
Mailing Address - City:HIGHTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-3055
Mailing Address - Country:US
Mailing Address - Phone:973-985-4341
Mailing Address - Fax:
Practice Address - Street 1:9 ASHTON LN
Practice Address - Street 2:
Practice Address - City:HIGHTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08520-3055
Practice Address - Country:US
Practice Address - Phone:973-985-4341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ002703-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist