Provider Demographics
NPI:1164660155
Name:BEAUFORT, ANETRA (MA,CFY-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANETRA
Middle Name:
Last Name:BEAUFORT
Suffix:
Gender:F
Credentials:MA,CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 MIDDLETON ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-4694
Mailing Address - Country:US
Mailing Address - Phone:803-378-2938
Mailing Address - Fax:
Practice Address - Street 1:2035 MIDDLETON ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4694
Practice Address - Country:US
Practice Address - Phone:803-378-2938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4384235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist