Healthcare Provider Details

I. General information

NPI: 1386507820
Provider Name (Legal Business Name): BELK DEVELOPMENTAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3519 CHESTNUT DR
HAZEL CREST IL
60429-1044
US

IV. Provider business mailing address

3519 CHESTNUT DR
HAZEL CREST IL
60429-1044
US

V. Phone/Fax

Practice location:
  • Phone: 312-371-4024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL BELK
Title or Position: OWNER
Credential:
Phone: 312-371-4024