Individual
JESSICA CHAVA BETAHARON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
191 S EAST ST, FREDERICK, MD 21701-5918
(301) 644-6000
Mailing address
800 S FREDERICK AVE STE 101, GAITHERSBURG, MD 20877-4151
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
09962
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5416281
—
MD
Enumeration date
09/01/2020
Last updated
11/19/2021
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