Provider Demographics
NPI:1346597135
Name:KINKAID, BETHANY (SLP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:KINKAID
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 FURROW PL
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2433
Mailing Address - Country:US
Mailing Address - Phone:631-721-5493
Mailing Address - Fax:
Practice Address - Street 1:443 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1237
Practice Address - Country:US
Practice Address - Phone:516-887-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022299235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist