Provider Demographics
NPI:1255471850
Name:BETHIN, PATRICIA BERNICE
Entity Type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:BERNICE
Last Name:BETHIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4387 MANOR LN
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-1120
Mailing Address - Country:US
Mailing Address - Phone:716-648-1959
Mailing Address - Fax:
Practice Address - Street 1:960 WEST MAPLE COURT
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:NY
Practice Address - Zip Code:14059-9530
Practice Address - Country:US
Practice Address - Phone:716-805-1555
Practice Address - Fax:716-805-1444
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007920-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist