Provider Demographics
NPI:1528210242
Name:BECKMAN, KELLI RAYNEL
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:RAYNEL
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1057
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58602-1057
Mailing Address - Country:US
Mailing Address - Phone:701-227-3010
Mailing Address - Fax:701-225-1968
Practice Address - Street 1:107 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5637
Practice Address - Country:US
Practice Address - Phone:701-227-3010
Practice Address - Fax:701-225-1968
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1022235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND55208Medicaid