Provider Demographics
NPI:1013088574
Name:MATTHEWS, BETSY GINGER (MSP, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:GINGER
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MIDLAND DR
Mailing Address - Street 2:
Mailing Address - City:GRANITEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29829-4038
Mailing Address - Country:US
Mailing Address - Phone:803-270-4658
Mailing Address - Fax:
Practice Address - Street 1:118 PARK AVE SW
Practice Address - Street 2:SUITE 600
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3835
Practice Address - Country:US
Practice Address - Phone:803-270-4658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3335235Z00000X
GASLP005095235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0428Medicaid