Provider Demographics
NPI:1902339708
Name:BECK SPEECH CLINIC
Entity Type:Organization
Organization Name:BECK SPEECH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP, BCS-F
Authorized Official - Phone:817-915-0901
Mailing Address - Street 1:3610 SMITH BARRY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PANTEGO
Mailing Address - State:TX
Mailing Address - Zip Code:76013-4633
Mailing Address - Country:US
Mailing Address - Phone:817-915-0901
Mailing Address - Fax:817-795-0085
Practice Address - Street 1:3610 SMITH BARRY RD STE 101
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-4633
Practice Address - Country:US
Practice Address - Phone:817-915-0901
Practice Address - Fax:817-795-0085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17666235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty