Provider Demographics
NPI:1235771981
Name:RICHARDSON, BETHANY (MA, CCC-SLP, CBIS)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP, CBIS
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:RADIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP, CBIS
Mailing Address - Street 1:811 9TH ST NW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-2126
Mailing Address - Country:US
Mailing Address - Phone:616-915-8940
Mailing Address - Fax:
Practice Address - Street 1:407 3RD ST SE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4470
Practice Address - Country:US
Practice Address - Phone:701-857-5514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1797235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist