Provider Demographics
NPI:1780896720
Name:UNTERBERGER, BETHANY G (SLP)
Entity type:Individual
Prefix:MISS
First Name:BETHANY
Middle Name:G
Last Name:UNTERBERGER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HARDENBURGH RD
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566
Mailing Address - Country:US
Mailing Address - Phone:845-551-9443
Mailing Address - Fax:
Practice Address - Street 1:3 HARDENBURGH RD
Practice Address - Street 2:
Practice Address - City:PINE BUSH
Practice Address - State:NY
Practice Address - Zip Code:12566
Practice Address - Country:US
Practice Address - Phone:845-551-9443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL5215235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist