Provider Demographics
NPI:1639587033
Name:KUSEK, BETHANY (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:KUSEK
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 1:624 PINEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-1055
Mailing Address - Country:US
Mailing Address - Phone:402-643-2902
Mailing Address - Fax:402-643-6731
Practice Address - Street 1:446 PINEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-1053
Practice Address - Country:US
Practice Address - Phone:402-643-2902
Practice Address - Fax:402-643-6731
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1736235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist