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General NPI Number Information
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NPI Number | 1770457558
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Entity Type | Organization
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Legal Business Name | BEACON PATHWAYS, PLLC
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Dates
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Enumeration Date | 10/03/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 306 WOLF DEN CIRCLE
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City | DAVIS JUNCTION
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State | IL
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Zip | 61020
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Country | US
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Telephone | 815-997-6654
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Fax |
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Provider Business Mailing Address
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Address Line | 1643 N ALPINE RD STE 104 PMB515
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City | ROCKFORD
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State | IL
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Zip | 61107-1464
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Country | US
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Telephone | 815-997-6654
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMANTHA KRISTINE TRAUM
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Credential | MSW, LCSW
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Telephone | 815-997-6654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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