Provider Demographics
NPI:1225552383
Name:BETTENCOURT, AMBER ROSE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ROSE
Last Name:BETTENCOURT
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 1:53 S MAIN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4829
Mailing Address - Country:US
Mailing Address - Phone:408-771-3647
Mailing Address - Fax:
Practice Address - Street 1:53 S MAIN ST APT 3
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4829
Practice Address - Country:US
Practice Address - Phone:408-771-3647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1744235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty