Healthcare Provider Details

I. General information

NPI: 1003129511
Provider Name (Legal Business Name): BETHANY PRISCILLA GONCZY AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETHANY P. COOK/COOKE AUD

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W UNION ST
ATHENS OH
45701-2313
US

IV. Provider business mailing address

275 W UNION ST
ATHENS OH
45701-2313
US

V. Phone/Fax

Practice location:
  • Phone: 740-594-3571
  • Fax: 740-592-2212
Mailing address:
  • Phone: 740-594-3571
  • Fax: 740-592-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA-0269
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA-01741
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: