Provider Demographics
NPI:1649344284
Name:BELTZ, SHEILA R (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:R
Last Name:BELTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 S PARK AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-4128
Mailing Address - Country:US
Mailing Address - Phone:618-988-1757
Mailing Address - Fax:618-988-1700
Practice Address - Street 1:1220 S PARK AVE
Practice Address - Street 2:SUITE D
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-4128
Practice Address - Country:US
Practice Address - Phone:618-988-1757
Practice Address - Fax:618-988-1700
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1618888Medicare UPIN
IL175533Medicare UPIN
IL061890Medicare UPIN
IL0047003Medicare UPIN
IL455456Medicare UPIN
IL442206Medicare UPIN