Individual
MRS. BEATRICE MONETTE FORTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
2545 SHERIDAN DR, TONAWANDA, NY 14150-9478
(716) 833-4884
Mailing address
94 AEGEAN AVENUE, AMHERST, NY 14228
(716) 525-1439
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
015190
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015190
NEW YORK STATE LICENSE
NY
Enumeration date
07/17/2009
Last updated
07/17/2009
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