Healthcare Provider Details

I. General information

NPI: 1811726714
Provider Name (Legal Business Name): ALICEN GRACE BECKLEY M.S., CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 S 4TH ST
LEAVENWORTH KS
66048-5024
US

IV. Provider business mailing address

1335 NW BROAD ST
MURFREESBORO TN
37129-4428
US

V. Phone/Fax

Practice location:
  • Phone: 913-682-7500
  • Fax: 913-364-5401
Mailing address:
  • Phone: 888-362-8704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4001
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: