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General NPI Number Information
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NPI Number | 1205550720
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Entity Type | Individual
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Provider Name | NATASHA KIMBERLY BEALS LSW
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Gender | Female
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Dates
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Enumeration Date | 09/28/2022
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 1323 E 50TH ST STE 1009
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City | CHICAGO
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State | IL
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Zip | 60615-2905
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Country | US
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Telephone | 312-566-1702
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Fax |
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Provider Business Mailing Address
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Address Line | 10212 S VAN VLISSINGEN RD
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City | CHICAGO
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State | IL
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Zip | 60617-5639
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Country | US
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Telephone | 708-495-4236
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150.109032
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License Number State | IL
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