Healthcare Provider Details

I. General information

NPI: 1750074738
Provider Name (Legal Business Name): MALIYAH THAIS-SINCERE BECKWITH MS, CF-SLP; BS, RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 MORGANTOWN RD
BOWLING GREEN KY
42101-3644
US

IV. Provider business mailing address

980 MORGANTOWN RD
BOWLING GREEN KY
42101-3644
US

V. Phone/Fax

Practice location:
  • Phone: 270-495-1312
  • Fax:
Mailing address:
  • Phone: 270-495-1312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number308907
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-261620
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: