Bethany Jane Waggoner
Individual provider Active NPI Speech-Language Pathologist · Dawson Springs, KY
NPI 1720724958 · NPPES record last updated May 17, 2022
Key facts
- NPI
- 1720724958
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 277629 (KY)
- Practice address
- 100 W Ramsey St
Dawson Springs, KY 42408-1739 - Phone
- (813) 227-0797
- NPI assigned
- May 10, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 277629 | KY | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | |||
| Speech-Language Pathologist | 235Z00000X | 277629 | KY | Yes |
Addresses
Primary practice location
100 W Ramsey St
Dawson Springs, KY 42408-1739
Mailing address
5865 State Route 464
Mayfield, KY 42066-4551
Phone (270) 705-0314
Other practice location 1
115 Cayce Ave
Hopkinsville, KY 42240-3019
Phone (270) 886-4403
Other providers in Dawson Springs, KY
- Raegan M'Kenzie Richey
- Temeka Narie Shuford
- Ericka Sims
- Tradewater Pointe, LLC
- Courtney Cathrine Trimble
- Mariah Willett Webb
- Jeffrey Layne Winfrey
- Woodburn Pharmacy, LLC
- Kayla Woodfork
All providers in Dawson Springs, KY · Speech-Language Pathologist in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 17, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.