Provider Demographics
NPI:1457704892
Name:ANDERSON, BETHANY (SPEECH PATHOLOGY)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5273
Mailing Address - Country:US
Mailing Address - Phone:479-872-1800
Mailing Address - Fax:479-872-4654
Practice Address - Street 1:3201 2ND ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5273
Practice Address - Country:US
Practice Address - Phone:479-872-1800
Practice Address - Fax:479-872-4654
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P9030235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist