Provider Demographics
NPI:1770845067
Name:BEASLEY, ALYSON (ME)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:ME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4020
Mailing Address - Country:US
Mailing Address - Phone:919-777-0240
Mailing Address - Fax:
Practice Address - Street 1:113 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4020
Practice Address - Country:US
Practice Address - Phone:919-777-0240
Practice Address - Fax:919-777-0499
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9853235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist