Provider Demographics
NPI:1538226436
Name:CRISTINA, BETH A (MA CCC SLPL)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:CRISTINA
Suffix:
Gender:F
Credentials:MA CCC SLPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2528 MOUTRAY LN
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-2115
Mailing Address - Country:US
Mailing Address - Phone:630-222-9901
Mailing Address - Fax:
Practice Address - Street 1:2528 MOUTRAY LN
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-2115
Practice Address - Country:US
Practice Address - Phone:630-222-9901
Practice Address - Fax:630-222-9901
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008387235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist