Provider Demographics
NPI:1124399720
Name:CONWAY, BETHANY (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7333 NEW HAMPSHIRE AVE
Mailing Address - Street 2:UNIT 1217
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6958
Mailing Address - Country:US
Mailing Address - Phone:716-949-2036
Mailing Address - Fax:
Practice Address - Street 1:5000 14TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-6926
Practice Address - Country:US
Practice Address - Phone:716-949-2036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSLP000645235Z00000X
MD07166235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY235Z00000XMedicaid