Provider Demographics
NPI:1730693938
Name:HIGH, MARY BETH (MS SLP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:BETH
Last Name:HIGH
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MORNING GLORY CT
Mailing Address - Street 2:
Mailing Address - City:MT ZION
Mailing Address - State:IL
Mailing Address - Zip Code:62549-9705
Mailing Address - Country:US
Mailing Address - Phone:217-855-7571
Mailing Address - Fax:
Practice Address - Street 1:620 E GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4550
Practice Address - Country:US
Practice Address - Phone:217-362-3360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146001174235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146.001174Medicaid