Provider Demographics
NPI:1942448949
Name:BEAUFORD, TALISHE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TALISHE
Middle Name:
Last Name:BEAUFORD
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 1:5282 HICKORY WALK TER SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-4757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:920 DANNON VW SW STE 3203
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2161
Practice Address - Country:US
Practice Address - Phone:678-948-6632
Practice Address - Fax:888-972-3946
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007493235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist