Provider Demographics
NPI:1538769336
Name:BECKMANN, CARINA KATHLEEN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CARINA
Middle Name:KATHLEEN
Last Name:BECKMANN
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 1:1144 ENZOS WAY
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-8874
Mailing Address - Country:US
Mailing Address - Phone:707-535-9487
Mailing Address - Fax:
Practice Address - Street 1:1280 SUMMERFIELD RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-7313
Practice Address - Country:US
Practice Address - Phone:949-487-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24108235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist