Provider Demographics
NPI:1144672767
Name:ROSE, BETHANY R (AUD)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:R
Last Name:ROSE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 FOREST AVE
Mailing Address - Street 2:STE 331
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4933
Mailing Address - Country:US
Mailing Address - Phone:804-739-0031
Mailing Address - Fax:804-594-8822
Practice Address - Street 1:9109 STONY POINT DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1979
Practice Address - Country:US
Practice Address - Phone:804-828-0431
Practice Address - Fax:804-628-0950
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2102002929231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist