Provider Demographics
NPI:1972852267
Name:BEAULIEU, CHERI
Entity Type:Individual
Prefix:MS
First Name:CHERI
Middle Name:
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 SPICE HILL DR
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-1762
Mailing Address - Country:US
Mailing Address - Phone:860-267-7207
Mailing Address - Fax:
Practice Address - Street 1:72 SALMON BROOK DR
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2131
Practice Address - Country:US
Practice Address - Phone:860-780-6341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-03
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004552235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist