Provider Demographics
NPI:1295249696
Name:BECKWITH, JULIE ANNE (MHS, CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:BECKWITH
Suffix:
Gender:F
Credentials:MHS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S SANGAMON ST
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-2831
Mailing Address - Country:US
Mailing Address - Phone:708-367-4722
Mailing Address - Fax:
Practice Address - Street 1:1009 BLACKHAWK DR
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:IL
Practice Address - Zip Code:60484-3248
Practice Address - Country:US
Practice Address - Phone:708-367-4722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.005237235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146.005237OtherSTATE OF ILLINOIS PROFESSIONAL LICENSE