Basic Information
| Provider Information | |||||||||
| NPI: | 1508254459 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANDERMOLEN | ||||||||
| FirstName: | BETHANNE | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 85 CREEKSIDE DR | ||||||||
| Address2: | |||||||||
| City: | SUMMERVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294858193 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432701229 | ||||||||
| FaxNumber: | 8668559443 | ||||||||
| Practice Location | |||||||||
| Address1: | 9285 MEDICAL PLAZA DR | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294069126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437978282 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2014 | ||||||||
| LastUpdateDate: | 12/30/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 3828 | SC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 8348 | NC | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.