Basic Information
| Provider Information | |||||||||
| NPI: | 1285893669 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEASLEY | ||||||||
| FirstName: | CLARE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 LAKEWOOD DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MORRIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604503352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159426323 | ||||||||
| FaxNumber: | 8159426423 | ||||||||
| Practice Location | |||||||||
| Address1: | 1280 WINDHAM PKWY | ||||||||
| Address2: | |||||||||
| City: | ROMEOVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604461673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159426323 | ||||||||
| FaxNumber: | 8159426423 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2008 | ||||||||
| LastUpdateDate: | 12/20/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 149008380 | IL | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 1041C0700X | 149008380 | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.