Provider Demographics
NPI:1730243221
Name:BOND, BEVERLY
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:
Last Name:BOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PURDY
Mailing Address - State:MO
Mailing Address - Zip Code:65734-0248
Mailing Address - Country:US
Mailing Address - Phone:417-442-3216
Mailing Address - Fax:
Practice Address - Street 1:201 S 3RD ST
Practice Address - Street 2:
Practice Address - City:PURDY
Practice Address - State:MO
Practice Address - Zip Code:65734-0248
Practice Address - Country:US
Practice Address - Phone:417-442-3216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO466179108Medicaid