Healthcare Provider Details

I. General information

NPI: 1992638084
Provider Name (Legal Business Name): MRS. BETH ANNE THRONEBURG WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 1ST ST
PANA IL
62557-1415
US

IV. Provider business mailing address

1137 E 1800 NORTH RD
TOWER HILL IL
62571-8237
US

V. Phone/Fax

Practice location:
  • Phone: 217-562-4580
  • Fax:
Mailing address:
  • Phone: 217-254-8803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.006555
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: