| NPI | 1740972652 |
|---|---|
| Former Name | BETHANY MALM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: CO SLP.0005100) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: WY SP-1270) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2023-10-08 |