Provider Demographics
NPI:1952805228
Name:BEAUMONT SPEECH AND LANGUAGE LLC
Entity Type:Organization
Organization Name:BEAUMONT SPEECH AND LANGUAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENN-ABBEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, L-SLP, CCC
Authorized Official - Phone:504-344-5296
Mailing Address - Street 1:2260 HAZEL ST APT 7
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-1543
Mailing Address - Country:US
Mailing Address - Phone:504-344-5296
Mailing Address - Fax:
Practice Address - Street 1:2260 HAZEL ST APT 7
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-1543
Practice Address - Country:US
Practice Address - Phone:504-344-5296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX344248501Medicaid