Provider Demographics
NPI:1013060334
Name:BIBB, BERNATEEN CUNNINGHAM (ST)
Entity type:Individual
Prefix:
First Name:BERNATEEN
Middle Name:CUNNINGHAM
Last Name:BIBB
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 MURPHY BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-6002
Mailing Address - Country:US
Mailing Address - Phone:770-535-8372
Mailing Address - Fax:770-535-0252
Practice Address - Street 1:2360 MURPHY BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-6002
Practice Address - Country:US
Practice Address - Phone:770-535-8372
Practice Address - Fax:770-535-0252
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005527235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist