Provider Demographics
NPI:1427867845
Name:BEASLEY, TERESA JOAN (HID)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:JOAN
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:HID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 HARRIET ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3312
Mailing Address - Country:US
Mailing Address - Phone:507-313-0663
Mailing Address - Fax:
Practice Address - Street 1:71 E 2ND ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-5375
Practice Address - Country:US
Practice Address - Phone:507-452-2312
Practice Address - Fax:507-292-0842
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2955237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist