Provider Demographics
NPI:1376699827
Name:BEAULIEU, DOROTHY HENDRICKS
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:HENDRICKS
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:
Other - Last Name:HENDRICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2843 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-3845
Mailing Address - Country:US
Mailing Address - Phone:561-502-7273
Mailing Address - Fax:561-964-6006
Practice Address - Street 1:4733 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-3706
Practice Address - Country:US
Practice Address - Phone:561-381-3898
Practice Address - Fax:561-381-3899
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5243235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist