Provider Demographics
NPI:1679734867
Name:BEACH, LYNN D
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:D
Last Name:BEACH
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 1:3144 HUDSON MILL RD
Mailing Address - Street 2:
Mailing Address - City:RUFFIN
Mailing Address - State:SC
Mailing Address - Zip Code:29475-3590
Mailing Address - Country:US
Mailing Address - Phone:843-538-8753
Mailing Address - Fax:
Practice Address - Street 1:3144 HUDSON MILL RD
Practice Address - Street 2:
Practice Address - City:RUFFIN
Practice Address - State:SC
Practice Address - Zip Code:29475-3590
Practice Address - Country:US
Practice Address - Phone:843-538-8753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12111233235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist