MEDICARE: MISS LAURA BEACH

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

General Provider Information

NPI Number	:	1750775821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LAURA BEACH

Provider Business Mailing Address
First Line	:	385 E VALLEY CIR
Second Line	:	UNIT B
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81507-2683
Country	:	US
Telephone Number	:	814-494-3660
Fax Number	:

Provider Business Practice Location Address
First Line	:	2004 N 12TH ST
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-2982
Country	:	US
Telephone Number	:	970-256-6378
Fax Number	:

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

Provider Enumeration Date	:	03/26/2015
Last Update Date	:	03/26/2015

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Directions to “ MISS LAURA BEACH ” Practice Location

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