Provider Demographics
NPI:1659826899
Name:LOCKER, BEVERLY (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:LOCKER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:GOODSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3450 WIMBLEDON DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-4503
Mailing Address - Country:US
Mailing Address - Phone:850-434-3232
Mailing Address - Fax:
Practice Address - Street 1:3450 WIMBLEDON DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-4503
Practice Address - Country:US
Practice Address - Phone:850-434-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14823235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist