Provider Demographics
NPI:1548933732
Name:BEASLEY, LARRY LONNEL (MA, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:LONNEL
Last Name:BEASLEY
Suffix:
Gender:M
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 1:980 MORGANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-3644
Mailing Address - Country:US
Mailing Address - Phone:270-495-1312
Mailing Address - Fax:270-495-1351
Practice Address - Street 1:980 MORGANTOWN RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-3644
Practice Address - Country:US
Practice Address - Phone:270-495-1312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY271021235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist