Provider Demographics
NPI:1205550720
Name:BEALS, NATASHA KIMBERLY (LSW)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:KIMBERLY
Last Name:BEALS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10212 S VAN VLISSINGEN RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-5639
Mailing Address - Country:US
Mailing Address - Phone:708-495-4236
Mailing Address - Fax:
Practice Address - Street 1:1323 E 50TH ST STE 1009
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-2905
Practice Address - Country:US
Practice Address - Phone:312-566-1702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.109032104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker