Provider Demographics
NPI:1730421215
Name:MALAMATENIOS, BETHANY JENNIFER (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:JENNIFER
Last Name:MALAMATENIOS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 FIELDHOUSE
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0928
Mailing Address - Country:US
Mailing Address - Phone:949-276-6028
Mailing Address - Fax:
Practice Address - Street 1:37 FIELDHOUSE
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-0928
Practice Address - Country:US
Practice Address - Phone:949-276-6028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP17136235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist