Provider Demographics
NPI:1235701129
Name:BARBER, BETHANY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:BARBER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2538 VALLEYVIEW ST SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-4520
Mailing Address - Country:US
Mailing Address - Phone:616-550-0838
Mailing Address - Fax:
Practice Address - Street 1:3737 LAKE EASTBROOK BLVD SE STE 218
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5989
Practice Address - Country:US
Practice Address - Phone:616-528-0870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101005629235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist