Basic Information
| Provider Information | |||||||||
| NPI: | 1427482462 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEAUCHAMP | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14545 W INDIAN SCHOOL RD | ||||||||
| Address2: | |||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853959243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232426908 | ||||||||
| FaxNumber: | 6232369895 | ||||||||
| Practice Location | |||||||||
| Address1: | 20402 N 15TH AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850273636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6234454952 | ||||||||
| FaxNumber: | 6234455083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2013 | ||||||||
| LastUpdateDate: | 05/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SLP8003 | AZ | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.