Provider Demographics
NPI:1659988319
Name:RUDY, BETHANY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:RUDY
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 1:601 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2537
Mailing Address - Country:US
Mailing Address - Phone:717-572-3064
Mailing Address - Fax:
Practice Address - Street 1:333 WHEAT RIDGE DR
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-8558
Practice Address - Country:US
Practice Address - Phone:717-354-1858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013410235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty