Provider Demographics
NPI:1902024565
Name:BEAMSLEY, VIRGINIA L (MS,CCC-SP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:L
Last Name:BEAMSLEY
Suffix:
Gender:F
Credentials:MS,CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MILDA ST
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-7022
Mailing Address - Country:US
Mailing Address - Phone:505-722-2844
Mailing Address - Fax:505-863-3964
Practice Address - Street 1:1010 MILDA ST
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-7022
Practice Address - Country:US
Practice Address - Phone:505-722-2844
Practice Address - Fax:505-863-3964
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2879235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist