Provider Demographics
NPI:1699876938
Name:BETHKE, AUDREY (PHD)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:
Last Name:BETHKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 23RD ST
Mailing Address - Street 2:SFGH BUILDING 9, ROOM 130
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3504
Mailing Address - Country:US
Mailing Address - Phone:415-206-5852
Mailing Address - Fax:
Practice Address - Street 1:2550 23RD ST
Practice Address - Street 2:SFGH BUILDING 9, ROOM 130
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3504
Practice Address - Country:US
Practice Address - Phone:415-206-5852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent