Healthcare Provider Details

I. General information

NPI: 1164356325
Provider Name (Legal Business Name): BROOKLYN BETHKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 36TH AVE SW STE 110
MINOT ND
58701-7597
US

IV. Provider business mailing address

2625 N 19TH ST
BISMARCK ND
58503-0574
US

V. Phone/Fax

Practice location:
  • Phone: 701-222-3175
  • Fax: 701-222-3186
Mailing address:
  • Phone: 701-222-3175
  • Fax: 701-222-3186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number3138
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: