Individual
BETTY DETHOMASIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12479 W PALM LN, AVONDALE, AZ 85323-6400
(914) 490-7728
Mailing address
12479 W PALM LN, AVONDALE, AZ 85323-6400
(914) 490-7728
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP5169
AZ
Other
Enumeration date
05/01/2007
Last updated
07/08/2007
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