Basic Information
| Provider Information | |||||||||
| NPI: | 1598903668 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BETZOLD | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | |||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32 RAHLING CIR | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722239187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018215459 | ||||||||
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| Practice Location | |||||||||
| Address1: | 32 RAHLING CIR | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722239187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018215459 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2009 | ||||||||
| LastUpdateDate: | 01/28/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP#P8184 | AR | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.