Provider Demographics
NPI:1053765834
Name:RAINEY, BETTY (MED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:
Last Name:RAINEY
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61171 HIGHWAY 445
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-4771
Mailing Address - Country:US
Mailing Address - Phone:985-748-4857
Mailing Address - Fax:985-748-9093
Practice Address - Street 1:61171 HIGHWAY 445
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-4771
Practice Address - Country:US
Practice Address - Phone:985-748-4857
Practice Address - Fax:985-748-9093
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3257235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist