Provider Demographics
NPI:1043669369
Name:LUTES, BETHANY AMANDA (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:AMANDA
Last Name:LUTES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 OWLS NEST
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-5190
Mailing Address - Country:US
Mailing Address - Phone:919-444-2342
Mailing Address - Fax:
Practice Address - Street 1:35 OWLS NEST
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-5190
Practice Address - Country:US
Practice Address - Phone:919-444-2342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12302235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist