Provider Demographics
NPI:1558761106
Name:BORNAK, BETHANY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:BORNAK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 LOUCKS RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-7902
Mailing Address - Country:US
Mailing Address - Phone:717-885-0063
Mailing Address - Fax:717-793-2602
Practice Address - Street 1:1805 LOUCKS RD
Practice Address - Street 2:SUITE 800
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-7902
Practice Address - Country:US
Practice Address - Phone:717-885-0063
Practice Address - Fax:717-793-2602
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA7326394235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist