Provider Demographics
NPI:1376576512
Name:DETTMANN, BETSY BONIN (MA)
Entity Type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:BONIN
Last Name:DETTMANN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 BLUEGILL CT
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-7513
Mailing Address - Country:US
Mailing Address - Phone:641-627-5097
Mailing Address - Fax:641-828-5175
Practice Address - Street 1:1515 W. PLEASANT ST (126)
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-3354
Practice Address - Country:US
Practice Address - Phone:641-828-5007
Practice Address - Fax:641-828-5175
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00780235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist