Provider Demographics
NPI:1932924032
Name:CUNNINGHAM, BETTSY
Entity type:Individual
Prefix:
First Name:BETTSY
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 COUNTY ROAD 30 W
Mailing Address - Street 2:
Mailing Address - City:BERRY
Mailing Address - State:AL
Mailing Address - Zip Code:35546-2279
Mailing Address - Country:US
Mailing Address - Phone:205-792-4676
Mailing Address - Fax:
Practice Address - Street 1:2703 UNIVERSITY BLVD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-3226
Practice Address - Country:US
Practice Address - Phone:205-248-7064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3065235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist