Provider Demographics
NPI:1053057307
Name:PHASE & STAGE LLC
Entity Type:Organization
Organization Name:PHASE & STAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AVERY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:361-935-6990
Mailing Address - Street 1:33 LAUREL MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:CT
Mailing Address - Zip Code:06754-1723
Mailing Address - Country:US
Mailing Address - Phone:361-935-6990
Mailing Address - Fax:
Practice Address - Street 1:33 LAUREL MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:CT
Practice Address - Zip Code:06754-1723
Practice Address - Country:US
Practice Address - Phone:361-935-6990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty