Provider Demographics
NPI:1861739146
Name:BEALS, AMY (SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BEALS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:BEALS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19019 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3253
Mailing Address - Country:US
Mailing Address - Phone:818-697-4226
Mailing Address - Fax:818-501-8325
Practice Address - Street 1:19019 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3253
Practice Address - Country:US
Practice Address - Phone:818-697-4226
Practice Address - Fax:818-501-8325
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21244235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist