Provider Demographics
NPI:1710711817
Name:PILLOW, BEVERLY ARLENA (MEDCCCSLP)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ARLENA
Last Name:PILLOW
Suffix:
Gender:F
Credentials:MEDCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3259 CARMICHAEL PL
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-6202
Mailing Address - Country:US
Mailing Address - Phone:404-790-5491
Mailing Address - Fax:
Practice Address - Street 1:1860 ATKINSON RD STE 101
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5066
Practice Address - Country:US
Practice Address - Phone:404-790-5491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003356235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist