Doctor Name: | MISS BETHANY SUZANNE GENEVRO |
NPI Number: | 1205247319 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSCCCSLP |
License Number: | SL011871 |
Business Practice Address: | 918 Main Street Laporte, PA - 18626 |
Business Phone Number: | 5709467700 |
Business Fax Number: | |
Mailing Address: | 918 Main Street, Po Box 10 LAPORTE |
State: | PA |
Postal Code: | 18626 |
Phone Number: | 5709467700 |
Fax Number: | |
NPI Enumeration Date: | 05/12/2014 |
NPI Last Update Date: | 05/12/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SL011871 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |