Beth Dalton Moffitt, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146.004399 Issued in IL

Practice address

200 W Maple Ave
Mundelein, IL 60060-1785

Phone

(847) 949-2720

NPI assigned

Nov 20, 2017

Last updated

Nov 20, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1511136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511136000000",
    "number": "1457865909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 TRALEE CT",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600313776",
            "telephone_number": "847-336-1543",
            "fax_number": "847-336-1543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W MAPLE AVE",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600601785",
            "telephone_number": "847-949-2720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOFFITT",
        "first_name": "BETH",
        "middle_name": "DALTON",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-20",
        "last_updated": "2017-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146.004399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Mundelein, IL
• Providers in Mundelein, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.