Basic Information
| Provider Information | |||||||||
| NPI: | 1619062650 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEAVER | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 FERNWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260035030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042424557 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 MEDICAL PARK | ||||||||
| Address2: | WHEELING HOSPITAL INC | ||||||||
| City: | WHEELING | ||||||||
| State: | WV | ||||||||
| PostalCode: | 260036379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042433124 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SLP-0354 | WV | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | SP-6206 | 01 | OH | OHIO LICENSE | OTHER |