Provider Demographics
NPI:1942410717
Name:KHABO, BEVERLY S (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:S
Last Name:KHABO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 LAWRENCE ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-3804
Mailing Address - Country:US
Mailing Address - Phone:202-271-1791
Mailing Address - Fax:202-832-9552
Practice Address - Street 1:1701 LAWRENCE ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-3804
Practice Address - Country:US
Practice Address - Phone:202-271-1791
Practice Address - Fax:202-832-9552
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist