Provider Demographics
NPI:1780178350
Name:JEWETT, BETHANY NORMA (AUD)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:NORMA
Last Name:JEWETT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:NORMA
Other - Last Name:WITTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:988 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4227
Mailing Address - Country:US
Mailing Address - Phone:860-493-1950
Mailing Address - Fax:860-493-1961
Practice Address - Street 1:988 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4227
Practice Address - Country:US
Practice Address - Phone:860-493-1950
Practice Address - Fax:860-493-1961
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT610231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008081052Medicaid