Healthcare Provider Details

I. General information

NPI: 1063994747
Provider Name (Legal Business Name): KRISTEN LEE BEVER SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTEN LEE HAMILTON SLP

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N MILLER RD STE 150A
FAIRLAWN OH
44333-3713
US

IV. Provider business mailing address

629 N WILLOW ST
KENT OH
44240-2620
US

V. Phone/Fax

Practice location:
  • Phone: 330-867-2240
  • Fax: 330-630-3198
Mailing address:
  • Phone: 330-281-7645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCOND.2018867-SP
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.13694
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: