Provider Demographics
NPI:1003129511
Name:GONCZY, BETHANY PRISCILLA (AUD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:PRISCILLA
Last Name:GONCZY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:P
Other - Last Name:COOK/COOKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:275 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2313
Mailing Address - Country:US
Mailing Address - Phone:740-594-3571
Mailing Address - Fax:740-592-2212
Practice Address - Street 1:275 W UNION ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2313
Practice Address - Country:US
Practice Address - Phone:740-594-3571
Practice Address - Fax:740-592-2212
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA-0269237600000X
OHA-01741237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVA-0269OtherA-0269