Provider Demographics
NPI:1154748887
Name:TUCKER, BETHANY (AUD)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:MAGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:430 MCLAWS CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5655
Mailing Address - Country:US
Mailing Address - Phone:757-229-4004
Mailing Address - Fax:757-229-9992
Practice Address - Street 1:430 MCLAWS CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5655
Practice Address - Country:US
Practice Address - Phone:757-229-4004
Practice Address - Fax:757-229-9992
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1823231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist