Provider Demographics
NPI:1750404299
Name:GALLAGHER, BETHANY LYN (MS, SLP)
Entity type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:LYN
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7103 SHEFFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1628
Mailing Address - Country:US
Mailing Address - Phone:412-445-8824
Mailing Address - Fax:
Practice Address - Street 1:2225 OLD EMMORTON ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015
Practice Address - Country:US
Practice Address - Phone:410-515-4900
Practice Address - Fax:410-515-0777
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05301235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419800000Medicaid