Provider Demographics
NPI:1033369921
Name:BEAUCHAMP, AMANDA R (SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:R
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 POPPY DR
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72858-9202
Mailing Address - Country:US
Mailing Address - Phone:479-567-5564
Mailing Address - Fax:479-495-6336
Practice Address - Street 1:10668 LYDIA LN
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:AR
Practice Address - Zip Code:72833-6890
Practice Address - Country:US
Practice Address - Phone:479-495-3626
Practice Address - Fax:479-495-6336
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSPP8068235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR169666721Medicaid
ARSPP8068OtherSTATE LICENSE NUMBER
ARSPP8068OtherSTATE LICENSE NUMBER