1619957800 NPI number — MRS. BETH-ANN GRIESSER MCSWEENEY M.ED, CCC-SLP

Table of content: MRS. BETH-ANN GRIESSER MCSWEENEY M.ED, CCC-SLP (NPI 1619957800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619957800 NPI number — MRS. BETH-ANN GRIESSER MCSWEENEY M.ED, CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCSWEENEY
Provider First Name:
BETH-ANN
Provider Middle Name:
GRIESSER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED, CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAU
Provider Other First Name:
BETH-ANN
Provider Other Middle Name:
GRIESSER
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED, CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619957800
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2529 KINGS CREEK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAYES
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23072-4325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-595-5558
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6425 RICHMOND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23188-7202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-585-7176
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SA 7657 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 2202006889 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: S9150 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 8901597-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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