Provider Demographics
NPI:1487911632
Name:BEACH, JOELLE KHRISTEN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JOELLE
Middle Name:KHRISTEN
Last Name:BEACH
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 1:40 GINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-5340
Mailing Address - Country:US
Mailing Address - Phone:949-291-0575
Mailing Address - Fax:949-916-9242
Practice Address - Street 1:40 GINGHAM ST
Practice Address - Street 2:
Practice Address - City:TRABUCO CANYON
Practice Address - State:CA
Practice Address - Zip Code:92679-5340
Practice Address - Country:US
Practice Address - Phone:949-291-0575
Practice Address - Fax:949-916-9242
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 13226235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist