Provider Demographics
NPI:1962655001
Name:BEUTEL, JOANNA C (SLP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:C
Last Name:BEUTEL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:C
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:326 COLONIAL HILLS DR
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-6259
Mailing Address - Country:US
Mailing Address - Phone:336-613-5792
Mailing Address - Fax:
Practice Address - Street 1:1221 BROAD ST
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-3602
Practice Address - Country:US
Practice Address - Phone:919-552-4580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1208550235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist