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NPI Code Detail

MEDICARE: BETHANY ELIZABETH JERAE FERGUSON MA, CCC-SLP

MEDICARE: BETHANY ELIZABETH JERAE FERGUSON MA, CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist4951OK

General Provider Information

NPI Number : 1639797517
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETHANY ELIZABETH JERAE FERGUSON MA, CCC-SLP
Provider Business Mailing Address
First Line : 1213 N HARVEY AVE APT 2
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73103-3733
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9201 S I 35 SERVICE RD
Second Line :
City : MOORE
State : OK
Zip : 73160-9046
Country : US
Telephone Number : 405-601-4303
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2020
Last Update Date : 11/13/2020

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Directions to “ BETHANY ELIZABETH JERAE FERGUSON MA, CCC-SLP” Practice Location

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