Provider Demographics
NPI:1790222552
Name:BEVILL, BRITTANY LASHAE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LASHAE
Last Name:BEVILL
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 1:176 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-3311
Mailing Address - Country:US
Mailing Address - Phone:662-488-7716
Mailing Address - Fax:
Practice Address - Street 1:176 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-3311
Practice Address - Country:US
Practice Address - Phone:662-488-7716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3437235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist