Provider Demographics
NPI:1306189212
Name:SIMPSON, BETHANY B (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:B
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 ISABELLA BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-8001
Mailing Address - Country:US
Mailing Address - Phone:904-372-4070
Mailing Address - Fax:904-372-4075
Practice Address - Street 1:2730 ISABELLA BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-8001
Practice Address - Country:US
Practice Address - Phone:904-372-4070
Practice Address - Fax:904-372-4075
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11733235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist