Provider Demographics
NPI:1376602672
Name:EAGER KESSEL, BETSY LYNN (MS CCCSLP)
Entity Type:Individual
Prefix:MS
First Name:BETSY
Middle Name:LYNN
Last Name:EAGER KESSEL
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2698 MORGANS WALK
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-7518
Mailing Address - Country:US
Mailing Address - Phone:409-556-5554
Mailing Address - Fax:770-428-2112
Practice Address - Street 1:2698 MORGANS WALK
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-7518
Practice Address - Country:US
Practice Address - Phone:409-556-5554
Practice Address - Fax:770-428-2112
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP572235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00609056FMedicaid