Organization
MIDWEST DYSPHAGIA DIAGNOSTICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY BEAM MSCCC-SLP (SPEECH PATHOLOGIST)
(816) 986-0361
Entity
Organization
Contact information
Practice address
1375 SW 100TH RD, HOLDEN, MO 64040-8440
(816) 986-0361
(816) 817-0922
Mailing address
1375 SW 100TH RD, HOLDEN, MO 64040-8440
(816) 986-0361
(816) 817-0922
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2012041520
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
KA4003
MEDICARE PTAN
KS
01
—
MA6285
MEDICARE PTAN
MO
Enumeration date
04/11/2016
Last updated
09/20/2016
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