Provider Demographics
NPI:1598942435
Name:BEVERLY, PATRICIA A (MACCC-SP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:BEVERLY
Suffix:
Gender:F
Credentials:MACCC-SP
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 49663
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0082
Mailing Address - Country:US
Mailing Address - Phone:704-845-6134
Mailing Address - Fax:704-845-8024
Practice Address - Street 1:2101 SARDIS RD N
Practice Address - Street 2:SUITE 112
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-7711
Practice Address - Country:US
Practice Address - Phone:704-845-6134
Practice Address - Fax:704-845-8024
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7415325Medicaid