Provider Demographics
NPI:1053406561
Name:REYNOLDS, BETHANN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BETHANN
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SAINT CLAIR AVE. SW
Mailing Address - Street 2:BUILDING 6
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801
Mailing Address - Country:US
Mailing Address - Phone:256-533-3314
Mailing Address - Fax:256-533-3384
Practice Address - Street 1:600 SAINT CLAIR AVE. SW
Practice Address - Street 2:BUILDING 6
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-533-3314
Practice Address - Fax:256-533-3384
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL980235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51512415OtherBLUE CROSS AND BLUE SHIEL