Provider Demographics
NPI:1437782273
Name:BEACON INTEGRATED THERAPIES
Entity Type:Organization
Organization Name:BEACON INTEGRATED THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, SLP
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:608-320-9896
Mailing Address - Street 1:311 AMHERST CT
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1708
Mailing Address - Country:US
Mailing Address - Phone:608-320-9896
Mailing Address - Fax:
Practice Address - Street 1:311 AMHERST CT
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1708
Practice Address - Country:US
Practice Address - Phone:608-320-9896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146014493OtherIL STATE LICENSE