Provider Demographics
NPI:1245619394
Name:HILLARY, BETHANY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:HILLARY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11506 S WATERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-7937
Mailing Address - Country:US
Mailing Address - Phone:801-703-4865
Mailing Address - Fax:
Practice Address - Street 1:11506 S WATERSIDE RD
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-7937
Practice Address - Country:US
Practice Address - Phone:801-703-4865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9368181-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist