Provider Demographics
NPI:1437363017
Name:DEJOE, BETHANY LYNN (MS , CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:LYNN
Last Name:DEJOE
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 1:828 RUSSLEO DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4430
Mailing Address - Country:US
Mailing Address - Phone:615-243-4172
Mailing Address - Fax:615-356-2824
Practice Address - Street 1:828 RUSSLEO DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-4430
Practice Address - Country:US
Practice Address - Phone:615-243-4172
Practice Address - Fax:615-356-2824
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2160235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist