Provider Demographics
NPI:1952131393
Name:KOHNKE, BETHANEY LYNAE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BETHANEY
Middle Name:LYNAE
Last Name:KOHNKE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N GARFIELD AVE APT 20
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-4268
Mailing Address - Country:US
Mailing Address - Phone:626-808-7300
Mailing Address - Fax:
Practice Address - Street 1:801 N GARFIELD AVE APT 20
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-4268
Practice Address - Country:US
Practice Address - Phone:626-808-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13669235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist