Healthcare Provider Details

I. General information

NPI: 1568366482
Provider Name (Legal Business Name): ELIZABETH BEAL MED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 BROAD ST
WADSWORTH OH
44281-2319
US

IV. Provider business mailing address

4738 SALEMS WAY
MEDINA OH
44256-8288
US

V. Phone/Fax

Practice location:
  • Phone: 330-335-1440
  • Fax:
Mailing address:
  • Phone: 330-241-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberUA100337
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: