Individual
BETHANY LEE WALDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
21216 OLEAN BLVD STE 4, PORT CHARLOTTE, FL 33952-6722
(941) 766-8886
(941) 766-8804
Mailing address
215 SHUMAN BLVD STE 401, NAPERVILLE, IL 60563-8123
(630) 303-5380
(630) 303-5385
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AY211
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
204102500
U.S. DEPT OF LABOR
FL
01
—
2667047
AETNA
FL
05
—
600341900
—
FL
01
—
640004249
R.R. MEDICARE
FL
01
—
7139291
AETNA
FL
01
—
S0808
BLUE CROSS/BLUE SHIELD
FL
Enumeration date
10/05/2006
Last updated
08/08/2019
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