Healthcare Provider Details

I. General information

NPI: 1659032704
Provider Name (Legal Business Name): BETHANIE DON TELEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1752 E BULLARD AVE STE 101
FRESNO CA
93710-5864
US

IV. Provider business mailing address

2735 ROBERTS AVE
CLOVIS CA
93611-8546
US

V. Phone/Fax

Practice location:
  • Phone: 559-970-8277
  • Fax:
Mailing address:
  • Phone: 559-905-0716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number20121
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: