Provider Demographics
NPI:1700028321
Name:BEIFUSS, KATHLEEN (DT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BEIFUSS
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3729 N CLIFTON AVE
Mailing Address - Street 2:APT. #2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3811
Mailing Address - Country:US
Mailing Address - Phone:630-805-0376
Mailing Address - Fax:
Practice Address - Street 1:3729 N CLIFTON AVE
Practice Address - Street 2:APT. #2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3811
Practice Address - Country:US
Practice Address - Phone:630-805-0376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist