Provider Demographics
NPI:1114372265
Name:GEORGE, BECKY DIANNE (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:DIANNE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 N JEFFERSON ST UNIT F
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1296
Mailing Address - Country:US
Mailing Address - Phone:330-461-1805
Mailing Address - Fax:
Practice Address - Street 1:95 BLACK DR
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:OH
Practice Address - Zip Code:44230-1374
Practice Address - Country:US
Practice Address - Phone:330-658-2061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-4574235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist