Provider Demographics
NPI:1710575576
Name:KLIEGER, BETH ELLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ELLEN
Last Name:KLIEGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ELLEN
Other - Last Name:SCHUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2640 N AVONDALE AVE UNIT H
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6401
Mailing Address - Country:US
Mailing Address - Phone:872-261-8122
Mailing Address - Fax:
Practice Address - Street 1:5645 W CORCORAN
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644
Practice Address - Country:US
Practice Address - Phone:872-261-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0199141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical