Provider Demographics
NPI:1386119956
Name:DELEO, BETHANN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BETHANN
Middle Name:
Last Name:DELEO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WABANAKI WAY
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-5513
Mailing Address - Country:US
Mailing Address - Phone:781-249-7070
Mailing Address - Fax:
Practice Address - Street 1:18 WABANAKI WAY
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-5513
Practice Address - Country:US
Practice Address - Phone:781-249-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty