Provider Demographics
NPI:1972907988
Name:DEAN, BETSY
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:DEAN
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 1:1306 ARTISTS LN
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-8616
Mailing Address - Country:US
Mailing Address - Phone:410-638-5881
Mailing Address - Fax:
Practice Address - Street 1:138 INDUSTRY LN, UNIT 5A
Practice Address - Street 2:PEDIATRIC MOBILITY, LLC
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050
Practice Address - Country:US
Practice Address - Phone:443-752-1617
Practice Address - Fax:410-727-2186
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04458235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist