Basic Information
| Provider Information | |||||||||
| NPI: | 1801319678 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BANDY | ||||||||
| FirstName: | BETHANY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12110 CLAYTON RD | ||||||||
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| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631312516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149898150 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1323 E 28TH ST | ||||||||
| Address2: | |||||||||
| City: | JOPLIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648042966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4176255360 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2017 | ||||||||
| LastUpdateDate: | 07/24/2017 | ||||||||
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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 | 2013045301 | MO | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.