MEDICARE: CHRISTINE M BECK 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	SA805	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S1164	OTHER	FL	BC/BS OF FLORIDA

General Provider Information

NPI Number	:	1558349704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE M BECK SLP

Provider Business Mailing Address
First Line	:	4421 EAGLE CREEK CT
Second Line	:
City	:	ELKTON
State	:	FL
Zip	:	32033-2063
Country	:	US
Telephone Number	:	904-501-5285
Fax Number	:	904-826-3492

Provider Business Practice Location Address
First Line	:	4421 EAGLE CREEK CT
Second Line	:
City	:	ELKTON
State	:	FL
Zip	:	32033-2063
Country	:	US
Telephone Number	:	904-501-5285
Fax Number	:	904-826-3492

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	10/19/2007

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Directions to “ CHRISTINE M BECK SLP” Practice Location

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