Provider Demographics
NPI:1447939202
Name:BEATY, KARLY JOHNSON (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KARLY
Middle Name:JOHNSON
Last Name:BEATY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:KARLY
Other - Middle Name:MARIE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:12712 KINCAID LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-2809
Mailing Address - Country:US
Mailing Address - Phone:850-549-7494
Mailing Address - Fax:
Practice Address - Street 1:20 MAYO RD STE 105
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-1439
Practice Address - Country:US
Practice Address - Phone:410-956-7868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09514235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist