Provider Demographics
NPI:1598052235
Name:BETZ, MARILYN DIANE (HAS)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:DIANE
Last Name:BETZ
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 COUNTY ROAD 220
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-4374
Mailing Address - Country:US
Mailing Address - Phone:904-505-2051
Mailing Address - Fax:
Practice Address - Street 1:3180 COUNTY ROAD 220
Practice Address - Street 2:SUITE 3
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-4374
Practice Address - Country:US
Practice Address - Phone:904-505-2051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS3918235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist