Provider Demographics
NPI:1508012717
Name:GEBAUER, BETTY P (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:P
Last Name:GEBAUER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 COLONIAL DR. SCHENECTADY
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-5365
Mailing Address - Country:US
Mailing Address - Phone:518-369-7017
Mailing Address - Fax:
Practice Address - Street 1:1013 RED PINE DR
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-5512
Practice Address - Country:US
Practice Address - Phone:518-630-0480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008342235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist