Healthcare Provider Details

I. General information

NPI: 1083545495
Provider Name (Legal Business Name): LOREN BEARD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 N CLARK ST
CHICAGO IL
60657-5205
US

IV. Provider business mailing address

1277 COMMONWEALTH AVE APT 207
BOSTON MA
02134-3522
US

V. Phone/Fax

Practice location:
  • Phone: 872-266-8184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.115655
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: