Healthcare Provider Details

I. General information

NPI: 1962647057
Provider Name (Legal Business Name): JAYME BEAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N PECOS RD
HENDERSON NV
89074-1349
US

IV. Provider business mailing address

1400 COLORADO ST STE C
BOULDER CITY NV
89005-2490
US

V. Phone/Fax

Practice location:
  • Phone: 702-566-8255
  • Fax:
Mailing address:
  • Phone: 702-566-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-1125
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JAYME BEAL
Title or Position: OWNER
Credential: M.S. CCC/SLP
Phone: 702-566-8255