Healthcare Provider Details

I. General information

NPI: 1083595623
Provider Name (Legal Business Name): KYRA NOELLE BEARDALL BS, SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 N IDAHO RD
APACHE JUNCTION AZ
85119-1716
US

IV. Provider business mailing address

1575 W SOUTHERN AVE
APACHE JUNCTION AZ
85120-7456
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-7500
  • Fax:
Mailing address:
  • Phone: 480-982-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA14922
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: