Provider Demographics
NPI:1679221121
Name:ALDRICH, BETTY (HAS, BC-HIS)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:ALDRICH
Suffix:
Gender:F
Credentials:HAS, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6853 LAKE CHARLENE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-5747
Mailing Address - Country:US
Mailing Address - Phone:502-475-7106
Mailing Address - Fax:
Practice Address - Street 1:4455 BAYOU BLVD STE C
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-1928
Practice Address - Country:US
Practice Address - Phone:850-475-8887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80925237700000X
FLAS5561237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist