Provider Demographics
NPI:1487884128
Name:WORSTER, BETHANY (SLP)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:WORSTER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-0326
Mailing Address - Country:US
Mailing Address - Phone:207-564-3115
Mailing Address - Fax:207-564-0019
Practice Address - Street 1:1092A DOUTY HILL ROAD
Practice Address - Street 2:
Practice Address - City:SANGERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04479
Practice Address - Country:US
Practice Address - Phone:207-564-3115
Practice Address - Fax:207-564-0019
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEST1689235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432032999OtherMAINECARE