Healthcare Provider Details

I. General information

NPI: 1609989482
Provider Name (Legal Business Name): BEULAH MAE CHAPLIN SPEECH LANGUAGE PATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1039 N 8TH ST
ROCHELLE IL
61068-1411
US

IV. Provider business mailing address

1039 N 8TH ST
ROCHELLE IL
61068-1411
US

V. Phone/Fax

Practice location:
  • Phone: 815-562-4418
  • Fax:
Mailing address:
  • Phone: 815-562-4418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberBC60280498P
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: