Provider Demographics
NPI:1306910971
Name:HOMER, BEVERLY LOUISE (MS CCC SLP)
Entity type:Individual
Prefix:MISS
First Name:BEVERLY
Middle Name:LOUISE
Last Name:HOMER
Suffix:
Gender:F
Credentials:MS CCC SLP
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Other - Credentials:
Mailing Address - Street 1:401 S 400 E
Mailing Address - Street 2:BEVERLY HOMER MOUNTAIN LAND REHABILITATION
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010
Mailing Address - Country:US
Mailing Address - Phone:801-397-8163
Mailing Address - Fax:801-397-8051
Practice Address - Street 1:401 S 400 E
Practice Address - Street 2:BEVERLY HOMER MOUNTAIN LAND REHABILITATION
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010
Practice Address - Country:US
Practice Address - Phone:801-397-8151
Practice Address - Fax:801-397-8051
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5870932-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD6276Medicaid