Provider Demographics
NPI:1023697562
Name:LAFFERTY, BETHANY (ACN)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:
Last Name:LAFFERTY
Suffix:
Gender:F
Credentials:ACN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1085
Mailing Address - Street 2:
Mailing Address - City:CARNATION
Mailing Address - State:WA
Mailing Address - Zip Code:98014-1085
Mailing Address - Country:US
Mailing Address - Phone:425-405-5783
Mailing Address - Fax:
Practice Address - Street 1:4473 TOLT AVE
Practice Address - Street 2:
Practice Address - City:CARNATION
Practice Address - State:WA
Practice Address - Zip Code:98014-5050
Practice Address - Country:US
Practice Address - Phone:425-405-5783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education