Provider Demographics
NPI:1861652190
Name:BEVERIDGE, AMY CLAIRE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CLAIRE
Last Name:BEVERIDGE
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 1:415 CEDAR ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-3927
Mailing Address - Country:US
Mailing Address - Phone:505-224-7020
Mailing Address - Fax:
Practice Address - Street 1:415 CEDAR ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3927
Practice Address - Country:US
Practice Address - Phone:505-224-7020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4318235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist