Provider Demographics
NPI:1487318747
Name:GRODZIN, BETH (MSW, MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:GRODZIN
Suffix:
Gender:F
Credentials:MSW, MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2749
Mailing Address - Country:US
Mailing Address - Phone:847-877-1515
Mailing Address - Fax:
Practice Address - Street 1:1809 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2749
Practice Address - Country:US
Practice Address - Phone:847-877-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.006197235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist