Healthcare Provider Details

I. General information

NPI: 1831304773
Provider Name (Legal Business Name): SHAUNA J BEYER SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHAUNA J RUZICH SLP

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 BELLEVUE DRIVE
PADUCAH KY
42001-4614
US

IV. Provider business mailing address

622 BELLEVUE DRIVE
PADUCAH KY
42001-4614
US

V. Phone/Fax

Practice location:
  • Phone: 815-931-8595
  • Fax:
Mailing address:
  • Phone: 815-319-8595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146006731
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number279430
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: