Provider Demographics
NPI:1992909162
Name:BECKMAN, CHANNA GAE (MA,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHANNA
Middle Name:GAE
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:MA,CCC-SLP
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Mailing Address - Street 1:208 ISLAND BOULEVARD FI
Mailing Address - Street 2:
Mailing Address - City:FOX ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98333-9754
Mailing Address - Country:US
Mailing Address - Phone:253-549-7780
Mailing Address - Fax:253-549-7781
Practice Address - Street 1:4700 POINT FOSDICK DR NW STE 213
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1706
Practice Address - Country:US
Practice Address - Phone:253-851-5718
Practice Address - Fax:253-853-6922
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WALL00003090235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist