Provider Demographics
NPI:1225823073
Name:BOSTON, BETHANY JOY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:JOY
Last Name:BOSTON
Suffix:
Gender:
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 1:18906 FAIRFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-1558
Mailing Address - Country:US
Mailing Address - Phone:765-744-4083
Mailing Address - Fax:
Practice Address - Street 1:18906 FAIRFIELD BLVD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1558
Practice Address - Country:US
Practice Address - Phone:765-744-4083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22005686A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist