Basic Information
| Provider Information | |||||||||
| NPI: | 1851666846 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BETANCOURT | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AUD, CCC-A | ||||||||
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| OtherLastName: | BETANCOURT | ||||||||
| OtherFirstName: | VANESSA | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2222 E HIGHLAND AVE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850164872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022644834 | ||||||||
| FaxNumber: | 6022570082 | ||||||||
| Practice Location | |||||||||
| Address1: | 16427 N SCOTTSDALE RD STE 410 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852547102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8884954489 | ||||||||
| FaxNumber: | 6023250169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2012 | ||||||||
| LastUpdateDate: | 06/28/2019 | ||||||||
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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 | 231H00000X | DA10187 | AZ | Y | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | 9304 | NC | N | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.