Individual
MISS BETHANY SUZANNE GENEVRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSCCCSLP
Contact information
Practice address
918 MAIN STREET, LAPORTE, PA 18626
(570) 946-7700
Mailing address
918 MAIN STREET, PO BOX 10, LAPORTE, PA 18626
(570) 946-7700
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL011871
PA
Other
Enumeration date
05/12/2014
Last updated
05/12/2014
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