MEDICARE: BRIDGET BEACHAM CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP006174	GA

General Provider Information

NPI Number	:	1386920288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET BEACHAM CCC-SLP

Provider Business Mailing Address
First Line	:	9480 RIVER LAKE DR
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30075-5043
Country	:	US
Telephone Number	:	404-395-3756
Fax Number	:

Provider Business Practice Location Address
First Line	:	9480 RIVER LAKE DR
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30075-5043
Country	:	US
Telephone Number	:	404-395-3756
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2011
Last Update Date	:	10/25/2011

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Directions to “ BRIDGET BEACHAM CCC-SLP” Practice Location

Language	Start Address	Practice Location

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