Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 196810 | SC |
NPI | 1073944385 |
---|---|
Provider Name | Kelly Beauchamp |
First Address | Aiken, SC 29803 |
Second Address | Aiken, SC 29803-2109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2013 |
Last Update Date | 12/12/2013 |