Provider Demographics
NPI:1063994747
Name:BEVER, KRISTEN LEE (SLP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LEE
Last Name:BEVER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:LEE
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:629 N WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2620
Mailing Address - Country:US
Mailing Address - Phone:330-281-7645
Mailing Address - Fax:
Practice Address - Street 1:150 N MILLER RD STE 150A
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3713
Practice Address - Country:US
Practice Address - Phone:330-867-2240
Practice Address - Fax:330-630-3198
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.2018867-SP235Z00000X
OHSP.13694235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist