Healthcare Provider Details

I. General information

NPI: 1689969107
Provider Name (Legal Business Name): CRISTINE ALLISON BEACH M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 MAGUIRE RD STE 107-108
WINDERMERE FL
34786-7942
US

IV. Provider business mailing address

14680 SCOTT KEY DR
WINTER GARDEN FL
34787-0052
US

V. Phone/Fax

Practice location:
  • Phone: 407-473-8005
  • Fax: 321-236-6160
Mailing address:
  • Phone: 239-595-7348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 11517
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: