Provider Demographics
NPI:1750775821
Name:BEACH, LAURA
Entity type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:
Last Name:BEACH
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 1:385 E VALLEY CIR
Mailing Address - Street 2:UNIT B
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-2683
Mailing Address - Country:US
Mailing Address - Phone:814-494-3660
Mailing Address - Fax:
Practice Address - Street 1:2004 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2982
Practice Address - Country:US
Practice Address - Phone:970-256-6378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist