Provider Demographics
NPI:1477922466
Name:BEAVEN, NICHOLAS V (SLPA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:V
Last Name:BEAVEN
Suffix:
Gender:M
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 SW 74TH TER
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4128
Mailing Address - Country:US
Mailing Address - Phone:317-452-5395
Mailing Address - Fax:
Practice Address - Street 1:4600 SW 74TH TER
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-4128
Practice Address - Country:US
Practice Address - Phone:317-452-5395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-19
Last Update Date:2015-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI 24902355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant