Provider Demographics
NPI:1306507769
Name:MARKLEY, BETHANY PRUETT (MS CF-SLP)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:PRUETT
Last Name:MARKLEY
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:FAITH
Other - Last Name:PRUETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 S EDWARDS AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-2948
Mailing Address - Country:US
Mailing Address - Phone:404-725-4629
Mailing Address - Fax:
Practice Address - Street 1:401 S EDWARDS AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2948
Practice Address - Country:US
Practice Address - Phone:404-725-4629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist