Provider Demographics
NPI:1992837132
Name:BERNARD, BETH MARIE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:MARIE
Last Name:BERNARD
Suffix:
Gender:F
Credentials: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:HC 79 BOX 2485
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:65724-9739
Mailing Address - Country:US
Mailing Address - Phone:417-852-4090
Mailing Address - Fax:
Practice Address - Street 1:524 W MADISON ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-1945
Practice Address - Country:US
Practice Address - Phone:417-852-4090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004015147235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist