Beatty, Jackie Elaine

Beatty, Jackie Elaine is an sole proprietor health care provider with primary practice located at 750 Lakeshore Dr. , Pierson FL 32180. She recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Developmental Therapist, Speech, Language and Hearing Service Providers / Speech-Language Pathologist. Speech, Language and Hearing Service Providers / Speech-Language Pathologist is her primary health care specialty. Beatty, Jackie Elaine can be contacted via phone (321) 231-2962.

Contact Information

Primary practice address
750 Lakeshore Dr. Pierson FL 32180
Phone: (321) 231-2962
Fax: (888) 845-9818
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Developmental Therapist 222Q00000X SA8761 Florida
Speech, Language and Hearing Service Providers / Speech-Language Pathologist 235Z00000X SA8761 Florida

Profile Details

NPI number 1215962691
LBN Legal business name Beatty, Jackie Elaine
Credentials M.A. CCC-SLP
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 12th, 2006
Last updated Feb 12th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215962691 NPPES
Florida MEDICAID 000476900
Florida MEDICAID 890711100

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