Provider Demographics
NPI:1295244432
Name:HERLIEN, BETHANY LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:LYNN
Last Name:HERLIEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2262 RICHMOND DR
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-8928
Mailing Address - Country:US
Mailing Address - Phone:708-638-0965
Mailing Address - Fax:
Practice Address - Street 1:2262 RICHMOND DR
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-8928
Practice Address - Country:US
Practice Address - Phone:708-638-0965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009949235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist