Provider Demographics
NPI:1841522273
Name:BEAL, LAUREL A (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:A
Last Name:BEAL
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 1:229 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04654-5116
Mailing Address - Country:US
Mailing Address - Phone:207-255-7989
Mailing Address - Fax:
Practice Address - Street 1:247 MAIN ST
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654-3606
Practice Address - Country:US
Practice Address - Phone:207-255-7989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP801235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist