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NPI Code Detail

MEDICARE: KATHLEEN BEIFUSS DT

MEDICARE: KATHLEEN BEIFUSS DT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1222Q00000XDevelopmental TherapistIL

General Provider Information

NPI Number : 1700028321
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN BEIFUSS DT
Provider Business Mailing Address
First Line : 3729 N CLIFTON AVE
Second Line : APT. #2
City : CHICAGO
State : IL
Zip : 60613-3811
Country : US
Telephone Number : 630-805-0376
Fax Number :
Provider Business Practice Location Address
First Line : 3729 N CLIFTON AVE
Second Line : APT. #2
City : CHICAGO
State : IL
Zip : 60613-3811
Country : US
Telephone Number : 630-805-0376
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2009
Last Update Date : 09/09/2009

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Directions to “ KATHLEEN BEIFUSS DT” Practice Location

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