Provider Demographics
NPI:1982829818
Name:BEARD, KIM GRAY (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:GRAY
Last Name:BEARD
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 1:1610 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:DILLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17019-9672
Mailing Address - Country:US
Mailing Address - Phone:717-432-8369
Mailing Address - Fax:
Practice Address - Street 1:1610 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:DILLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17019-9672
Practice Address - Country:US
Practice Address - Phone:717-432-8369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000433L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017610810004Medicaid