Provider Demographics
NPI:1487261699
Name:BEECHAN, BROOKE ASHLEY (MS CCC-SLP/L)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:ASHLEY
Last Name:BEECHAN
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 GREEN ST APT 4
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-4132
Mailing Address - Country:US
Mailing Address - Phone:513-444-5860
Mailing Address - Fax:
Practice Address - Street 1:1712 GREEN ST APT 4
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-4132
Practice Address - Country:US
Practice Address - Phone:513-444-5860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL015366235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty