Provider Demographics
NPI:1255811980
Name:FRELIN, BETHANY MICHELLE (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:MICHELLE
Last Name:FRELIN
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:MS
Other - First Name:BETHANY
Other - Middle Name:MICHELLE
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1257 BRANDL DR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-3571
Mailing Address - Country:US
Mailing Address - Phone:817-897-4272
Mailing Address - Fax:
Practice Address - Street 1:1257 BRANDL DR SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-3571
Practice Address - Country:US
Practice Address - Phone:817-897-4272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114433235Z00000X
GASLP010908235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist