Provider Demographics
NPI:1134655707
Name:JUNSO, BETHANY ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANN
Last Name:JUNSO
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 1:1300 W MEDICINE LAKE DR APT 318
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-4856
Mailing Address - Country:US
Mailing Address - Phone:320-237-0252
Mailing Address - Fax:
Practice Address - Street 1:3001 HARBOR LN N STE 120
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5135
Practice Address - Country:US
Practice Address - Phone:763-551-3652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist