Provider Demographics
NPI:1134594559
Name:BEATY, PATTY ANNE (BSW/MHP)
Entity type:Individual
Prefix:MRS
First Name:PATTY
Middle Name:ANNE
Last Name:BEATY
Suffix:
Gender:F
Credentials:BSW/MHP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANNE
Other - Last Name:BEATY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSW/MHP
Mailing Address - Street 1:16342 N IL HWY 37
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-5007
Mailing Address - Country:US
Mailing Address - Phone:618-242-1510
Mailing Address - Fax:618-242-0958
Practice Address - Street 1:16342 N IL HIGHWAY 37
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-8178
Practice Address - Country:US
Practice Address - Phone:618-242-1510
Practice Address - Fax:618-242-6392
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker