Provider Demographics
NPI:1700428240
Name:KAMBIC, BEVERLY (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:KAMBIC
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 N 20TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-3803
Mailing Address - Country:US
Mailing Address - Phone:717-580-0302
Mailing Address - Fax:717-502-4454
Practice Address - Street 1:113 N 20TH ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-3803
Practice Address - Country:US
Practice Address - Phone:717-580-0302
Practice Address - Fax:717-502-4454
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL014430235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist