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General NPI Number Information
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NPI Number | 1336714823
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Entity Type | Individual
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Provider Name | SARAH ELIZABETH BEASLEY
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Gender | Female
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 9900 SHELBYVILLE RD STE 8
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City | LOUISVILLE
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State | KY
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Zip | 40223-2965
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Country | US
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Telephone | 502-915-8796
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Fax | 502-805-0765
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Provider Business Mailing Address
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Address Line | 9900 SHELBYVILLE RD STE 8
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City | LOUISVILLE
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State | KY
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Zip | 40223-2965
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Country | US
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Telephone | 502-915-8796
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Fax | 502-805-0765
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 2700760
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License Number State | KY
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