1932523396 NPI number — K-BEACH SPEECH, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932523396 NPI number — K-BEACH SPEECH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
K-BEACH SPEECH, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932523396
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 578
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENAI
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99611-0578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-252-6465
Provider Business Mailing Address Fax Number:
907-260-4166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36484 MEANDERING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOLDOTNA
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99669-6202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-252-6465
Provider Business Practice Location Address Fax Number:
907-260-4166
Provider Enumeration Date:
02/05/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
ANNAROSE
Authorized Official Middle Name:
NOELLE
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
907-252-6465

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  346 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)