Provider Demographics
NPI:1306254693
Name:WOOLVERTON, BETHANY SNOW (MS, CFY-SLP)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:SNOW
Last Name:WOOLVERTON
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CEDARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-3408
Mailing Address - Country:US
Mailing Address - Phone:501-626-2928
Mailing Address - Fax:501-771-7648
Practice Address - Street 1:109 CEDARWOOD DR
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-3408
Practice Address - Country:US
Practice Address - Phone:501-626-2928
Practice Address - Fax:501-771-7648
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8820235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist