Provider Demographics
NPI:1033469820
Name:SHAW, BEULAH BRAWNER (CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:BEULAH
Middle Name:BRAWNER
Last Name:SHAW
Suffix:
Gender:F
Credentials:CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 KLUMAC RD
Mailing Address - Street 2:APT 125B
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-5720
Mailing Address - Country:US
Mailing Address - Phone:704-636-5086
Mailing Address - Fax:704-636-7286
Practice Address - Street 1:728 KLUMAC RD
Practice Address - Street 2:APT 125B
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-5720
Practice Address - Country:US
Practice Address - Phone:704-636-5086
Practice Address - Fax:704-636-7286
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6702235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist