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General NPI Number Information
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NPI Number | 1528881133
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Entity Type | Individual
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Provider Name | TOYANNA A BEATHEA MSW, LSW
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Gender | Female
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Dates
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Enumeration Date | 11/02/2024
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Last Update Date | 11/02/2024
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Provider Practice Location Address
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Address Line | 1586 37TH AVE
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City | MOLINE
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State | IL
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Zip | 61265-7213
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Country | US
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Telephone | 309-944-7833
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Fax |
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Provider Business Mailing Address
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Address Line | 1084 W MAIN ST
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City | GALESBURG
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State | IL
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Zip | 61401-3472
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Country | US
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Telephone | 309-351-2697
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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 | 150113832
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License Number State | IL
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