Provider Demographics
NPI:1154367126
Name:SHAVER, BECKY CHAMBERS (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:CHAMBERS
Last Name:SHAVER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
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Mailing Address - Street 1:8904 CANTERBURY CV
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4345
Mailing Address - Country:US
Mailing Address - Phone:479-452-8477
Mailing Address - Fax:479-452-8477
Practice Address - Street 1:2801 OLD GREENWOOD RD STE 15
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4560
Practice Address - Country:US
Practice Address - Phone:479-629-1111
Practice Address - Fax:479-646-1804
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2010-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARSP#713235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR121416721Medicaid