Provider Demographics
NPI:1740426451
Name:STREET, BETTY GAIL (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:GAIL
Last Name:STREET
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 1:2949 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-2010
Mailing Address - Country:US
Mailing Address - Phone:276-596-6417
Mailing Address - Fax:276-596-6485
Practice Address - Street 1:2949 FRONT ST
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2010
Practice Address - Country:US
Practice Address - Phone:276-596-6417
Practice Address - Fax:276-596-6485
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202 002428235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist