Provider Demographics
NPI:1366139180
Name:COCKRAM, BETHANY
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:COCKRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:SEXTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:610 DEERFIELD LN NE
Mailing Address - Street 2:
Mailing Address - City:FLOYD
Mailing Address - State:VA
Mailing Address - Zip Code:24091-3724
Mailing Address - Country:US
Mailing Address - Phone:540-239-7075
Mailing Address - Fax:
Practice Address - Street 1:1997 S MAIN ST STE 601
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6606
Practice Address - Country:US
Practice Address - Phone:540-961-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202011386235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist