Provider Demographics
NPI:1235136185
Name:BEACH, ANGELA M (MS CCC-A)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:BEACH
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:BUCKINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 E KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2793
Mailing Address - Country:US
Mailing Address - Phone:812-987-2009
Mailing Address - Fax:
Practice Address - Street 1:117 E KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2793
Practice Address - Country:US
Practice Address - Phone:502-584-3573
Practice Address - Fax:502-583-6364
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0976237700000X
KY0468231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000477921OtherANTHEM
IN200298810Medicaid
KY70001300Medicaid
KY0685507Medicare PIN