Provider Demographics
NPI:1134412380
Name:BEAUTIFUL BEGINNINGS: A SPEECH AND LANGUAGE PROGRAM, LLC
Entity type:Organization
Organization Name:BEAUTIFUL BEGINNINGS: A SPEECH AND LANGUAGE PROGRAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIOM
Authorized Official - Suffix:
Authorized Official - Credentials:MED,CCC-SLP
Authorized Official - Phone:919-358-2520
Mailing Address - Street 1:1507 BRAMBLE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-1209
Mailing Address - Country:US
Mailing Address - Phone:919-358-2520
Mailing Address - Fax:919-479-7300
Practice Address - Street 1:1507 BRAMBLE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27712-1209
Practice Address - Country:US
Practice Address - Phone:919-358-2520
Practice Address - Fax:919-479-7300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7785235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty