=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003761479
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BEVERLY MICHELE PILCHER MACCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2026
-----------------------------------------------------
Last Update Date | 03/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3350 N 4TH ST
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55412-2616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-668-2295
-----------------------------------------------------
Fax | 612-668-2280
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3340 GAYNOR ST
-----------------------------------------------------
City | HOPKINS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55305-4617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-239-3979
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 314933
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------