Provider Demographics
NPI:1134008204
Name:BROSEY, BETHANY GRACE
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:GRACE
Last Name:BROSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:GRACE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2712 N 31ST ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-8473
Mailing Address - Country:US
Mailing Address - Phone:636-345-6839
Mailing Address - Fax:
Practice Address - Street 1:1531 E BRADFORD PKWY STE 210-4
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6539
Practice Address - Country:US
Practice Address - Phone:417-881-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20250375242355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant