Provider Demographics
NPI:1578041018
Name:BETTS, WYNETTE C (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:WYNETTE
Middle Name:C
Last Name:BETTS
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 1:106 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:TX
Mailing Address - Zip Code:75551-2519
Mailing Address - Country:US
Mailing Address - Phone:903-796-4194
Mailing Address - Fax:
Practice Address - Street 1:505 RABBIT BLVD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:TX
Practice Address - Zip Code:75551-2439
Practice Address - Country:US
Practice Address - Phone:903-796-8115
Practice Address - Fax:903-799-1014
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101139235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist