Provider Demographics
NPI:1780142141
Name:BEETS, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BEETS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 E WALNUT ST STE B
Mailing Address - Street 2:
Mailing Address - City:SHELBINA
Mailing Address - State:MO
Mailing Address - Zip Code:63468-1324
Mailing Address - Country:US
Mailing Address - Phone:573-588-4165
Mailing Address - Fax:
Practice Address - Street 1:600 S ATTERBERRY ST
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:MO
Practice Address - Zip Code:63530-1246
Practice Address - Country:US
Practice Address - Phone:660-239-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist