Provider Demographics
NPI:1518649177
Name:EYDT-BEEBE, ANWYN MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANWYN
Middle Name:MARIE
Last Name:EYDT-BEEBE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 DEVON SPRINGS WAY APT 608
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-4565
Mailing Address - Country:US
Mailing Address - Phone:217-508-5925
Mailing Address - Fax:
Practice Address - Street 1:3925 MAYNARDVILLE HWY STE 1
Practice Address - Street 2:
Practice Address - City:MAYNARDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37807-3552
Practice Address - Country:US
Practice Address - Phone:865-333-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7917235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist