Provider Demographics
NPI:1316453772
Name:LEGGITT, BETH
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:LEGGITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:SAINTE MARIE
Mailing Address - State:IL
Mailing Address - Zip Code:62459-0185
Mailing Address - Country:US
Mailing Address - Phone:618-455-3396
Mailing Address - Fax:618-455-3393
Practice Address - Street 1:111 WEST MOUND STREET
Practice Address - Street 2:
Practice Address - City:SAINTE MARIE
Practice Address - State:IL
Practice Address - Zip Code:62459-0185
Practice Address - Country:US
Practice Address - Phone:618-455-3396
Practice Address - Fax:618-455-3393
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.004962235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist