Provider Demographics
NPI:1114080900
Name:FLEMING, BEVERLY PITTARD (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:PITTARD
Last Name:FLEMING
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ROCKHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6434
Mailing Address - Country:US
Mailing Address - Phone:864-275-2510
Mailing Address - Fax:864-627-8531
Practice Address - Street 1:18 ROCKHAMPTON DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6434
Practice Address - Country:US
Practice Address - Phone:864-275-2510
Practice Address - Fax:864-627-8531
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6404235Z00000X
SC4626235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA1082Medicaid
NC7412193Medicaid