Provider Demographics
NPI:1174013221
Name:MCCORMICK, BETSY (MS)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 FORT DEFIANCE RD
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:VA
Mailing Address - Zip Code:24437-2001
Mailing Address - Country:US
Mailing Address - Phone:540-245-5043
Mailing Address - Fax:
Practice Address - Street 1:184 FORT DEFIANCE RD
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:VA
Practice Address - Zip Code:24437-2001
Practice Address - Country:US
Practice Address - Phone:540-245-5043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA22022002209235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty