Provider Demographics
NPI:1154744209
Name:NEWSOME, BETHANY D (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:D
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 OLD CHILLICOTHE RD SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-2383
Mailing Address - Country:US
Mailing Address - Phone:740-774-3307
Mailing Address - Fax:
Practice Address - Street 1:942 OLD CHILLICOTHE ROAD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160
Practice Address - Country:US
Practice Address - Phone:740-774-3307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP7325235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist