Provider Demographics
NPI:1114285434
Name:BETTINGER, ERIN LEE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:LEE
Last Name:BETTINGER
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 1:17320 MOORE RD
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841-9530
Mailing Address - Country:US
Mailing Address - Phone:301-476-0174
Mailing Address - Fax:301-710-0604
Practice Address - Street 1:17320 MOORE RD
Practice Address - Street 2:
Practice Address - City:BOYDS
Practice Address - State:MD
Practice Address - Zip Code:20841-9530
Practice Address - Country:US
Practice Address - Phone:301-476-0174
Practice Address - Fax:301-710-0604
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06746235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist