Provider Demographics
NPI:1326211483
Name:PARKER, BENTLEY L (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:BENTLEY
Middle Name:L
Last Name:PARKER
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 BUCKHEAD DR
Mailing Address - Street 2:
Mailing Address - City:PIKE ROAD
Mailing Address - State:AL
Mailing Address - Zip Code:36064-2258
Mailing Address - Country:US
Mailing Address - Phone:334-279-6110
Mailing Address - Fax:
Practice Address - Street 1:298 JAY ST
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-6062
Practice Address - Country:US
Practice Address - Phone:334-361-6008
Practice Address - Fax:334-491-0500
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1414235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist