Jesse Blake Beasley, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP010688 Issued in GA

Practice address

500 Spring St SE Ste 101
Gainesville, GA 30501-3773

Phone

(770) 615-7676

NPI assigned

Sep 17, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lifting Spirits Therapy Services, Inc

  • Pediatric Occupational Therapist
  • Gainesville, GA
  • NPI 1083891907
  NPD (past)
• Northeast Georgia Speech Center, Inc.

  • Speech-Language Pathologist
  • Gainesville, GA
  • NPI 1013088715
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568678400000",
    "number": "1295385607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 SPRING ST SE STE 101",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013773",
            "telephone_number": "770-615-7676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SPRING ST SE STE 101",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013773",
            "telephone_number": "770-615-7676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEASLEY",
        "first_name": "JESSE",
        "middle_name": "BLAKE",
        "name_prefix": "Mr.",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-09-17",
        "last_updated": "2019-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP010688",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "841619876",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bayada Home Health Care, Inc.
• Madison Mandula Bazemore, PA
• Mary Beall
• Virgil Emmitt Beall, MD
• Alexander Robert Bearup, CAA
• Whitney Buchanan Beaton, PT
• Tamara Christianne Beaty, D.C.
• Samantha Rae Beauchamp, DO
• Beautiful Bloom Counseling & Consulting LLC
• Joshua Brian Becher, PHARM.D.

• Speech-Language Pathologist in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.