Provider Demographics
NPI:1598884892
Name:WAHL, BETHANY ANNE (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:ANNE
Last Name:WAHL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 FAIRFIELD LN
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:PA
Mailing Address - Zip Code:15057-2386
Mailing Address - Country:US
Mailing Address - Phone:724-307-3437
Mailing Address - Fax:
Practice Address - Street 1:TELEMEDICINE SERVICES
Practice Address - Street 2:1104 FAIRFIELD LN
Practice Address - City:MC DONALD
Practice Address - State:PA
Practice Address - Zip Code:15057-1505
Practice Address - Country:US
Practice Address - Phone:724-307-3437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8686235Z00000X
PASL008978235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS9296OtherBCBSF IDENTIFICATION #