Provider Demographics
NPI:1225486970
Name:BERSCHE, BETHANY (MS SLP CCC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:BERSCHE
Suffix:
Gender:F
Credentials:MS SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 S MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-1765
Mailing Address - Country:US
Mailing Address - Phone:918-609-0496
Mailing Address - Fax:
Practice Address - Street 1:5550 W COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-3672
Practice Address - Country:US
Practice Address - Phone:918-609-0496
Practice Address - Fax:918-847-0570
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist