Provider Demographics
NPI:1841566189
Name:BEAUFAIT, KATHLEEN (LAC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:BEAUFAIT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7740 REDLANDS ST
Mailing Address - Street 2:#G2084
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8452
Mailing Address - Country:US
Mailing Address - Phone:310-420-8181
Mailing Address - Fax:
Practice Address - Street 1:20911 EARL ST
Practice Address - Street 2:SUITE 330
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4352
Practice Address - Country:US
Practice Address - Phone:310-540-0300
Practice Address - Fax:310-542-5900
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12166171100000X
CA3727235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist