MEDICARE: MS. AMANDA CATHERINE BEVERLY 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	5923	LA

General Provider Information

NPI Number	:	1881829893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA CATHERINE BEVERLY CCC-SLP

Provider Business Mailing Address
First Line	:	7429 RUE HENRI
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-7525
Country	:	US
Telephone Number	:	225-921-7686
Fax Number	:

Provider Business Practice Location Address
First Line	:	7429 RUE HENRI
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-7525
Country	:	US
Telephone Number	:	225-921-7686
Fax Number	:

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

Provider Enumeration Date	:	05/19/2009
Last Update Date	:	05/19/2009

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Directions to “ MS. AMANDA CATHERINE BEVERLY CCC-SLP” Practice Location

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