Provider Demographics
NPI:1841472057
Name:BEALL, ROSALYN S (SLP)
Entity type:Individual
Prefix:
First Name:ROSALYN
Middle Name:S
Last Name:BEALL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-2338
Mailing Address - Country:US
Mailing Address - Phone:417-336-6775
Mailing Address - Fax:
Practice Address - Street 1:223 KENTLING AVE
Practice Address - Street 2:
Practice Address - City:HIGHLANDVILLE
Practice Address - State:MO
Practice Address - Zip Code:65669-7904
Practice Address - Country:US
Practice Address - Phone:417-443-3361
Practice Address - Fax:417-443-2013
Is Sole Proprietor?:No
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTC 0402681235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0402681OtherTC