Provider Demographics
NPI:1104066349
Name:GUEVARA, BETHANY (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:GUEVARA
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3377 FOX RUN RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-3705
Mailing Address - Country:US
Mailing Address - Phone:717-767-5634
Mailing Address - Fax:717-767-5657
Practice Address - Street 1:3377 FOX RUN RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:PA
Practice Address - Zip Code:17315-3705
Practice Address - Country:US
Practice Address - Phone:717-767-5634
Practice Address - Fax:717-767-5657
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-28
Last Update Date:2014-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009436235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
119814OtherVITALSTIM THERAPY PROVIDER
PA12095826OtherAMERICAN SPEECH LANGUAGE HEARING ASSOCIATION
PASL009436OtherPA STATE BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS