Provider Demographics
NPI:1316224314
Name:BEAUVAIS, HEATHER JO (SLPA)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:JO
Last Name:BEAUVAIS
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 S ALMA SCHOOL RD STE 145
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3049
Mailing Address - Country:US
Mailing Address - Phone:602-320-3273
Mailing Address - Fax:480-855-8384
Practice Address - Street 1:1745 S ALMA SCHOOL RD STE 145
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3049
Practice Address - Country:US
Practice Address - Phone:602-320-3273
Practice Address - Fax:480-855-8384
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA75232355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant