Provider Demographics
NPI:1457820201
Name:KREK, BETHANY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:KREK
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 1:3713 STORMY GALE PL
Mailing Address - Street 2:
Mailing Address - City:CASTLE HAYNE
Mailing Address - State:NC
Mailing Address - Zip Code:28429-6234
Mailing Address - Country:US
Mailing Address - Phone:301-331-1335
Mailing Address - Fax:910-500-0126
Practice Address - Street 1:432 EASTWOOD RD STE 1C
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1872
Practice Address - Country:US
Practice Address - Phone:301-331-1335
Practice Address - Fax:910-500-0126
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14222235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist