Healthcare Provider Details

I. General information

NPI: 1073443966
Provider Name (Legal Business Name): MANON BEEKEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 FOOTHILL BLVD
OAKLAND CA
94606-2322
US

IV. Provider business mailing address

319 FOOTHILL BLVD
OAKLAND CA
94606-2322
US

V. Phone/Fax

Practice location:
  • Phone: 706-840-6420
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number35081
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: