Provider Demographics
NPI:1346242518
Name:BEATON, JANICE MARY (AUD CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:MARY
Last Name:BEATON
Suffix:
Gender:F
Credentials:AUD CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14185 W MEADOWSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-2427
Mailing Address - Country:US
Mailing Address - Phone:262-821-5853
Mailing Address - Fax:262-786-3769
Practice Address - Street 1:36500 AURORA DR
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:WI
Practice Address - Zip Code:53066-4899
Practice Address - Country:US
Practice Address - Phone:262-434-5364
Practice Address - Fax:262-434-5350
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI194-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41122500Medicaid