Provider Demographics
NPI:1538413422
Name:KELLEY, BETHANY GRIFFITH (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:GRIFFITH
Last Name:KELLEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2994
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98807-2994
Mailing Address - Country:US
Mailing Address - Phone:509-435-0481
Mailing Address - Fax:
Practice Address - Street 1:524 W INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4721
Practice Address - Country:US
Practice Address - Phone:509-435-0481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60294869235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist