Provider Demographics
NPI:1336609239
Name:BEAUMONT FEEDING & SPEECH SOLUTIONS LLC
Entity Type:Organization
Organization Name:BEAUMONT FEEDING & SPEECH SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:BEAUMONT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:320-200-4473
Mailing Address - Street 1:8617 WHITE OAK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-9477
Mailing Address - Country:US
Mailing Address - Phone:320-200-4473
Mailing Address - Fax:320-584-2660
Practice Address - Street 1:402 RED RIVER AVE N STE 5
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:MN
Practice Address - Zip Code:56320-1523
Practice Address - Country:US
Practice Address - Phone:320-204-6181
Practice Address - Fax:320-584-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1871870485OtherNPPES