1104066349 NPI number — BETHANY GUEVARA M.S. CCC/SLP

Table of content: BETHANY GUEVARA M.S. CCC/SLP (NPI 1104066349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104066349 NPI number — BETHANY GUEVARA M.S. CCC/SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUEVARA
Provider First Name:
BETHANY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S. CCC/SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104066349
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3377 FOX RUN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17315-3705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-767-5634
Provider Business Mailing Address Fax Number:
717-767-5657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3377 FOX RUN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17315-3705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-767-5634
Provider Business Practice Location Address Fax Number:
717-767-5657
Provider Enumeration Date:
02/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SL009436 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 119814 . This is a "VITALSTIM THERAPY PROVIDER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12095826 . This is a "AMERICAN SPEECH LANGUAGE HEARING ASSOCIATION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: SL009436 . This is a "PA STATE BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com