Individual
MRS. BEVERLY A. MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.,CCC-SLP
Contact information
Practice address
801 5TH AVE SE, DEVILS LAKE, ND 58301-3649
(701) 662-7690
(701) 662-7684
Mailing address
801 5TH AVE SE, DEVILS LAKE, ND 58301-3649
(701) 662-7690
(701) 662-7684
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
429
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
59067
—
ND
Enumeration date
01/09/2007
Last updated
07/09/2007
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