Healthcare Provider Details

I. General information

NPI: 1831236686
Provider Name (Legal Business Name): CAROL DEANE BEACH M.A., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1367 W HARVARD AVE
ROSEBURG OR
97470-2838
US

IV. Provider business mailing address

1367 W HARVARD AVE
ROSEBURG OR
97471-2838
US

V. Phone/Fax

Practice location:
  • Phone: 541-672-8868
  • Fax: 541-672-1142
Mailing address:
  • Phone: 541-672-8868
  • Fax: 541-672-1142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number20315
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: