Healthcare Provider Details

I. General information

NPI: 1083595623
Provider Name (Legal Business Name): KYRA NOELLE BEARDALL MS, CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 N ARIZONA AVE STE 105
CHANDLER AZ
85225-7122
US

IV. Provider business mailing address

3160 N ARIZONA AVE STE 105
CHANDLER AZ
85225-7122
US

V. Phone/Fax

Practice location:
  • Phone: 480-365-9981
  • Fax:
Mailing address:
  • Phone: 480-365-9981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP17506
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: