MEDICARE: RAMONA BEACH M.S. CCC SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP-275	WY

General Provider Information

NPI Number	:	1215195839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMONA BEACH M.S. CCC SLP

Provider Business Mailing Address
First Line	:	2724 BRIARWOOD LN
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4352
Country	:	US
Telephone Number	:	307-362-0012
Fax Number	:	307-362-0013

Provider Business Practice Location Address
First Line	:	2724 BRIARWOOD LN
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4352
Country	:	US
Telephone Number	:	307-362-0012
Fax Number	:	307-362-0013

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	05/30/2008

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Directions to “ RAMONA BEACH M.S. CCC SLP” Practice Location

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