Provider Demographics
NPI:1356680516
Name:WAY, BETHANY R L (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:R L
Last Name:WAY
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 1:1133 OLD DIRT RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-6969
Mailing Address - Country:US
Mailing Address - Phone:814-312-8209
Mailing Address - Fax:
Practice Address - Street 1:1133 OLD DIRT RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-6969
Practice Address - Country:US
Practice Address - Phone:814-312-8209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010768235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist