MEDICARE: SUSAN BECKMAN LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180.001737	IL

General Provider Information

NPI Number	:	1598303042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN BECKMAN LCPC

Provider Business Mailing Address
First Line	:	4821 S LAKE CAMELOT DR
Second Line	:
City	:	MAPLETON
State	:	IL
Zip	:	61547-9550
Country	:	US
Telephone Number	:	309-256-2627
Fax Number	:

Provider Business Practice Location Address
First Line	:	4821 S LAKE CAMELOT DR
Second Line	:
City	:	MAPLETON
State	:	IL
Zip	:	61547-9550
Country	:	US
Telephone Number	:	309-256-2627
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2019
Last Update Date	:	12/16/2019

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