MEDICARE: LAUREL A BEAL MA, 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	SP801	ME

General Provider Information

NPI Number	:	1841522273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREL A BEAL MA, CCC-SLP

Provider Business Mailing Address
First Line	:	229 RIDGE RD
Second Line	:
City	:	MARSHFIELD
State	:	ME
Zip	:	04654-5116
Country	:	US
Telephone Number	:	207-255-7989
Fax Number	:

Provider Business Practice Location Address
First Line	:	247 MAIN ST
Second Line	:
City	:	MACHIAS
State	:	ME
Zip	:	04654-3606
Country	:	US
Telephone Number	:	207-255-7989
Fax Number	:

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

Provider Enumeration Date	:	02/10/2010
Last Update Date	:	02/10/2010

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