Provider Demographics
NPI:1093180267
Name:BEAL BUTLER & ASSOCIATES
Entity Type:Organization
Organization Name:BEAL BUTLER & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS-BEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-351-9355
Mailing Address - Street 1:14501 S DOBSON
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419
Mailing Address - Country:US
Mailing Address - Phone:708-351-9355
Mailing Address - Fax:
Practice Address - Street 1:14501 DOBSON AVE
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-1929
Practice Address - Country:US
Practice Address - Phone:708-351-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency