Provider Demographics
NPI:1255089215
Name:SHIVERS, BETHANY L (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:L
Last Name:SHIVERS
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 1:523 FELLOWSHIP RD STE 290
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3418
Mailing Address - Country:US
Mailing Address - Phone:856-424-5552
Mailing Address - Fax:845-424-5559
Practice Address - Street 1:523 FELLOWSHIP RD STE 290
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3418
Practice Address - Country:US
Practice Address - Phone:856-424-5552
Practice Address - Fax:845-424-5559
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01123600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist