Provider Demographics
NPI:1487202990
Name:BEVER, BETHANY GAIL (BA, SLPA)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:GAIL
Last Name:BEVER
Suffix:
Gender:F
Credentials:BA, SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 EMERSON PLACE DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701-3058
Mailing Address - Country:US
Mailing Address - Phone:870-500-7006
Mailing Address - Fax:
Practice Address - Street 1:735 ROBIN ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-6834
Practice Address - Country:US
Practice Address - Phone:870-231-5434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant