Provider Demographics
NPI:1679945778
Name:BEAULAC, DAVID ARMAND (MA, BC-HIS)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ARMAND
Last Name:BEAULAC
Suffix:
Gender:M
Credentials:MA, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 ELM ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3523
Mailing Address - Country:US
Mailing Address - Phone:518-798-6428
Mailing Address - Fax:518-798-6430
Practice Address - Street 1:62 ELM ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3523
Practice Address - Country:US
Practice Address - Phone:518-798-6428
Practice Address - Fax:518-798-6430
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000006888237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist