Provider Demographics
NPI:1932523396
Name:K-BEACH SPEECH, LLC
Entity Type:Organization
Organization Name:K-BEACH SPEECH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNAROSE
Authorized Official - Middle Name:NOELLE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:907-252-6465
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-0578
Mailing Address - Country:US
Mailing Address - Phone:907-252-6465
Mailing Address - Fax:907-260-4166
Practice Address - Street 1:36484 MEANDERING RD
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-6202
Practice Address - Country:US
Practice Address - Phone:907-252-6465
Practice Address - Fax:907-260-4166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK346235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty