Provider Demographics
NPI:1689001398
Name:WETHERILL, CARA BETH (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:BETH
Last Name:WETHERILL
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 1:631 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-1499
Mailing Address - Country:US
Mailing Address - Phone:419-673-7248
Mailing Address - Fax:419-675-0681
Practice Address - Street 1:631 SILVER ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-1499
Practice Address - Country:US
Practice Address - Phone:419-673-7248
Practice Address - Fax:419-675-0681
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11649235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist