Provider Demographics
NPI:1912558800
Name:BETTES, MAIREL MURRAY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAIREL
Middle Name:MURRAY
Last Name:BETTES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CUMBERLAND COURT
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045
Mailing Address - Country:US
Mailing Address - Phone:336-408-6016
Mailing Address - Fax:
Practice Address - Street 1:7900 BROAD RIVER RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2355
Practice Address - Country:US
Practice Address - Phone:803-476-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7255235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist