Provider Demographics
NPI:1306985163
Name:ANDERSEN, BEVERLY RUTH (MS CCC-A)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:RUTH
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6250 E PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3841
Mailing Address - Country:US
Mailing Address - Phone:602-336-6991
Mailing Address - Fax:
Practice Address - Street 1:1946 W MORTEN AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-6977
Practice Address - Country:US
Practice Address - Phone:602-336-6991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAUD0009231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ927337OtherAHCCCS