Provider Demographics
NPI:1083111702
Name:WHITE, BETHIANA MAGALLANES (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETHIANA
Middle Name:MAGALLANES
Last Name:WHITE
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 1:8009 LAKE PLEASANT DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-3005
Mailing Address - Country:US
Mailing Address - Phone:805-844-4758
Mailing Address - Fax:
Practice Address - Street 1:14450 BROOK DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193
Practice Address - Country:US
Practice Address - Phone:571-589-2867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist