Provider Demographics
NPI:1629324744
Name:BEAUSOLEIL, ROSE
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:BEAUSOLEIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 E BEL AIRE DR
Mailing Address - Street 2:301
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-6600
Mailing Address - Country:US
Mailing Address - Phone:847-212-1035
Mailing Address - Fax:
Practice Address - Street 1:2630 E BEL AIRE DR
Practice Address - Street 2:301
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-6600
Practice Address - Country:US
Practice Address - Phone:847-212-1035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist