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General NPI Number Information
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NPI Number | 1710366778
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Entity Type | Organization
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Legal Business Name | AMANDA M. BEEDY
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Dates
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Enumeration Date | 05/23/2015
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Last Update Date | 05/23/2015
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Provider Practice Location Address
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Address Line | 1105 CURTISS ST
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-4694
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Country | US
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Telephone | 773-895-6252
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Fax |
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Provider Business Mailing Address
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Address Line | 10560 CANTERBURY ST
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City | WESTCHESTER
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State | IL
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Zip | 60154-4233
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Country | US
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Telephone | 773-895-6252
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MS. AMANDA M BEEDY
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Credential | LCSW
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Telephone | 773-895-6252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 149.014130
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License Number State | IL
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