Provider Demographics
NPI:1952621914
Name:BEAUBRUN- DE JESUS, CAROLYN F (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:F
Last Name:BEAUBRUN- DE JESUS
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9648 US 301 S # 224
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-5442
Mailing Address - Country:US
Mailing Address - Phone:305-343-9490
Mailing Address - Fax:
Practice Address - Street 1:10821 BOYETTE ROAD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569
Practice Address - Country:US
Practice Address - Phone:305-343-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA-8098235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist