Basic Information
| Provider Information | |||||||||
| NPI: | 1851537427 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ECONOMOU | ||||||||
| FirstName: | BETH | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S. CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12319 HIGHLAND RD | ||||||||
| Address2: | SUITE 501 | ||||||||
| City: | HARTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483532946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8109911211 | ||||||||
| FaxNumber: | 8109911656 | ||||||||
| Practice Location | |||||||||
| Address1: | 12319 HIGHLAND RD | ||||||||
| Address2: | SUITE 501 | ||||||||
| City: | HARTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483532946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8109911211 | ||||||||
| FaxNumber: | 8109911656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2008 | ||||||||
| LastUpdateDate: | 10/17/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 01094255 | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.