Provider Demographics
NPI:1518199967
Name:SHAFFER, BETHANY (SLP)
Entity Type:Individual
Prefix:MISS
First Name:BETHANY
Middle Name:
Last Name:SHAFFER
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 1:15 AGGIE CT
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-9603
Mailing Address - Country:US
Mailing Address - Phone:814-932-4975
Mailing Address - Fax:
Practice Address - Street 1:15 AGGIE CT
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-9603
Practice Address - Country:US
Practice Address - Phone:814-932-4975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06050235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist