Individual
BETHANY SELF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
1215 E FOX FARM RD, CHEYENNE, WY 82007-2556
(307) 763-5587
Mailing address
309 SYCAMORE AVE, EATON, CO 80615-9069
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP.0005100
CO
235Z00000X
Speech-Language Pathologist
SP-1270
WY
Other
Enumeration date
05/22/2023
Last updated
10/08/2023
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