Provider Demographics
NPI:1083029953
Name:BEASTER, MARY (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BEASTER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 GEORGES ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:ME
Mailing Address - Zip Code:04861-3912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:117 EASTERN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:ME
Practice Address - Zip Code:04864-4512
Practice Address - Country:US
Practice Address - Phone:207-273-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP2416235Z00000X
MEST2339235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist