Provider Demographics
NPI:1053420224
Name:SEABOURN, BEVERLY JOLENE (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:JOLENE
Last Name:SEABOURN
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 ABBOTS LN
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-8049
Mailing Address - Country:US
Mailing Address - Phone:940-382-2736
Mailing Address - Fax:940-382-1317
Practice Address - Street 1:1108 ABBOTS LN
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-8049
Practice Address - Country:US
Practice Address - Phone:940-382-2736
Practice Address - Fax:940-382-1317
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12340235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX517698OtherBLUE CROSS BLUE SHIELD