Provider Demographics
NPI:1962614271
Name:BEAUGEZ, KIMBERLY
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:BEAUGEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:BEAUGEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC,SLP
Mailing Address - Street 1:20942 NAPA LOOP
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-9691
Mailing Address - Country:US
Mailing Address - Phone:239-400-1705
Mailing Address - Fax:223-298-7637
Practice Address - Street 1:9500 CORKSCREW PALMS CIR STE 5
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3307
Practice Address - Country:US
Practice Address - Phone:239-400-1705
Practice Address - Fax:223-298-7637
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6971235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021626600Medicaid
FL890399900Medicare ID - Type Unspecified