Provider Demographics
NPI:1255566410
Name:PARKS, BETHANY (MS)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WALL ST
Mailing Address - Street 2:714 KEC
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1912
Mailing Address - Country:US
Mailing Address - Phone:512-626-9687
Mailing Address - Fax:
Practice Address - Street 1:1000 WALL ST
Practice Address - Street 2:714 KEC
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-1912
Practice Address - Country:US
Practice Address - Phone:512-626-9687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS