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General NPI Number Information
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NPI Number | 1437782273
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Entity Type | Organization
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Legal Business Name | BEACON INTEGRATED THERAPIES
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Dates
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Enumeration Date | 02/20/2020
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 311 AMHERST CT
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City | VERNON HILLS
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State | IL
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Zip | 60061-1708
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Country | US
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Telephone | 608-320-9896
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Fax |
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Provider Business Mailing Address
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Address Line | 311 AMHERST CT
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City | VERNON HILLS
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State | IL
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Zip | 60061-1708
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Country | US
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Telephone | 608-320-9896
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, SLP
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Name | AMY KRAUS
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Credential | SLP
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Telephone | 608-320-9896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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