Provider Demographics
NPI:1902957939
Name:GALLAGHER, BEVERLY BECKER (SLP)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:BECKER
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 BAY ESPLANADE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33767-1410
Mailing Address - Country:US
Mailing Address - Phone:727-692-8877
Mailing Address - Fax:727-536-6006
Practice Address - Street 1:14141 46TH ST N
Practice Address - Street 2:SUITE 1202
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3868
Practice Address - Country:US
Practice Address - Phone:727-535-6746
Practice Address - Fax:727-536-6006
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist