Provider Demographics
NPI:1861599078
Name:HIEBER, BETHANY G (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:G
Last Name:HIEBER
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 1:6569 N. CHARLES STREET
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5086
Mailing Address - Country:US
Mailing Address - Phone:443-849-2087
Mailing Address - Fax:443-849-2656
Practice Address - Street 1:6569 N. CHARLES STREET
Practice Address - Street 2:SUITE 401
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-5086
Practice Address - Country:US
Practice Address - Phone:443-849-2087
Practice Address - Fax:443-849-2656
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist