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General NPI Number Information
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NPI Number | 1013318484
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Entity Type | Individual
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Provider Name | ROSE BEAUJOUR MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/04/2014
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Last Update Date | 09/04/2014
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Provider Practice Location Address
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Address Line | 25 PINE CONE DR
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City | PALM COAST
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State | FL
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Zip | 32164-8423
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Country | US
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Telephone | 800-796-0923
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Fax | 800-796-0926
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Provider Business Mailing Address
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Address Line | PO BOX 352530
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City | PALM COAST
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State | FL
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Zip | 32135-2530
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Country | US
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Telephone | 800-796-0923
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Fax | 800-796-0926
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 12124611
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 004149
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License Number State | CT
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