Provider Demographics
NPI:1487224598
Name:LORMIS, BETHANY (SLP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:LORMIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 CAMELLIA RD
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:GA
Mailing Address - Zip Code:31320-6728
Mailing Address - Country:US
Mailing Address - Phone:912-980-9633
Mailing Address - Fax:
Practice Address - Street 1:383 CAMELLIA RD
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:GA
Practice Address - Zip Code:31320-6728
Practice Address - Country:US
Practice Address - Phone:912-980-9633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
GASLP011622235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist