Provider Demographics
NPI:1043470784
Name:BETANCOURT, DANELLE H (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANELLE
Middle Name:H
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 TIFFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4299
Mailing Address - Country:US
Mailing Address - Phone:919-453-2615
Mailing Address - Fax:
Practice Address - Street 1:2275 RUIN CREEK RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27537-8732
Practice Address - Country:US
Practice Address - Phone:252-438-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4417235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist