Provider Demographics
NPI:1114770625
Name:BETTS, EMILEE (MED)
Entity Type:Individual
Prefix:
First Name:EMILEE
Middle Name:
Last Name:BETTS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3256 N VALDOSTA RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1778
Mailing Address - Country:US
Mailing Address - Phone:229-560-6944
Mailing Address - Fax:
Practice Address - Street 1:3256 N VALDOSTA RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1778
Practice Address - Country:US
Practice Address - Phone:229-560-6944
Practice Address - Fax:888-450-0379
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003965235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist