Provider Demographics
NPI:1043057342
Name:TEDFORD, BETTY (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:TEDFORD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2089 S ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-6807
Mailing Address - Country:US
Mailing Address - Phone:307-248-0312
Mailing Address - Fax:
Practice Address - Street 1:2089 S ALLEN RD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-6807
Practice Address - Country:US
Practice Address - Phone:307-248-0312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12068674-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist