Provider Demographics
NPI:1649402793
Name:BEACON SPEECH ASSOCIATES, LLC
Entity Type:Organization
Organization Name:BEACON SPEECH ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:MATTOS
Authorized Official - Last Name:DELORME
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:919-440-5786
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27528-0629
Mailing Address - Country:US
Mailing Address - Phone:919-440-5786
Mailing Address - Fax:919-573-0759
Practice Address - Street 1:804 SARAZEN DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-3921
Practice Address - Country:US
Practice Address - Phone:919-440-5786
Practice Address - Fax:919-573-0759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-21
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200286Medicaid