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Individual

BETHANY MARIE FONSECA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2300 21ST ST N, TEXAS CITY, TX 77590-5208
(409) 916-0300
Mailing address
6717 N OAK DR, DICKINSON, TX 77539-8404
(832) 618-4287

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
TX
2355S0801X
Speech-Language Assistant
235Z00000X
Speech-Language Pathologist
Primary
TX

Other

Enumeration date
02/02/2018
Last updated
01/06/2023
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