MEDICARE: KATHY V BEATTY MS, 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-2398	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000392296	OTHER	OH	ANTHEM BCBS

General Provider Information

NPI Number	:	1679512875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY V BEATTY MS, CCC-SLP

Provider Business Mailing Address
First Line	:	4806 TIMBER COMMONS DR
Second Line	:	STE. B
City	:	SANDUSKY
State	:	OH
Zip	:	44870-7161
Country	:	US
Telephone Number	:	419-621-1166
Fax Number	:

Provider Business Practice Location Address
First Line	:	4806 TIMBER COMMONS DR
Second Line	:	STE. B
City	:	SANDUSKY
State	:	OH
Zip	:	44870-7161
Country	:	US
Telephone Number	:	419-621-1166
Fax Number	:

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	07/08/2007

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