Provider Demographics
NPI:1679512875
Name:BEATTY, KATHY V (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:V
Last Name:BEATTY
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 1:4806 TIMBER COMMONS DR
Mailing Address - Street 2:STE. B
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-7161
Mailing Address - Country:US
Mailing Address - Phone:419-621-1166
Mailing Address - Fax:
Practice Address - Street 1:4806 TIMBER COMMONS DR
Practice Address - Street 2:STE. B
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7161
Practice Address - Country:US
Practice Address - Phone:419-621-1166
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-2398235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000392296OtherANTHEM BCBS