Healthcare Provider Details

I. General information

NPI: 1235089202
Provider Name (Legal Business Name): BETH ONTROP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W JACKSON ST
MORRIS IL
60450-1845
US

IV. Provider business mailing address

2024 TALLER RD
MORRIS IL
60450-6833
US

V. Phone/Fax

Practice location:
  • Phone: 779-379-2654
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.117665
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: