Provider Demographics
NPI:1083611891
Name:HATHERILL, BETSY ANN (MS, CCC-A)
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:ANN
Last Name:HATHERILL
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6199 CENTRAL CITY BLVD
Mailing Address - Street 2:SUITE 122
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-3818
Mailing Address - Country:US
Mailing Address - Phone:409-765-5500
Mailing Address - Fax:409-744-8508
Practice Address - Street 1:26222 RANCH RD 12
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-4903
Practice Address - Country:US
Practice Address - Phone:512-858-0300
Practice Address - Fax:512-858-2714
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50601231H00000X, 231HA2500X
237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX022196203Medicaid
TX580034Medicare PIN