Individual
MR. JESSE BLAKE BEASLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CCC-SLP
Contact information
Practice address
500 SPRING ST SE STE 101, GAINESVILLE, GA 30501-3773
(770) 615-7676
Mailing address
500 SPRING ST SE STE 101, GAINESVILLE, GA 30501-3773
(770) 615-7676
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP010688
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
841619876
—
GA
Enumeration date
09/17/2019
Last updated
09/17/2019
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