Provider Demographics
NPI:1275825390
Name:COFFIN, BETHANN BODDUM (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETHANN
Middle Name:BODDUM
Last Name:COFFIN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 CUMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4049
Mailing Address - Country:US
Mailing Address - Phone:925-256-8382
Mailing Address - Fax:925-256-8382
Practice Address - Street 1:150 GRAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3781
Practice Address - Country:US
Practice Address - Phone:510-451-5800
Practice Address - Fax:510-451-5802
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-08
Last Update Date:2011-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP10153235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist