Provider Demographics
NPI:1316057698
Name:WAYWOOD, BETH ANN (AUD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:WAYWOOD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 PINNACLE POINT DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223
Mailing Address - Country:US
Mailing Address - Phone:803-509-7200
Mailing Address - Fax:803-509-7213
Practice Address - Street 1:1040 PINNACLE POINT DRIVE
Practice Address - Street 2:
Practice Address - City:COL
Practice Address - State:SC
Practice Address - Zip Code:29223
Practice Address - Country:US
Practice Address - Phone:803-509-7200
Practice Address - Fax:803-509-7213
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002055A231H00000X
SC3940231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00818653OtherRAILROAD MEDICARE
000000343052OtherANTHEM
IN200060920Medicaid
INP00844267OtherRAILROAD MEDICARE
000000343052OtherANTHEM
INP00844267OtherRAILROAD MEDICARE
IN265130KMedicare PIN