Provider Demographics
NPI:1114804721
Name:BEACH, CALLIANNE MARIE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CALLIANNE
Middle Name:MARIE
Last Name:BEACH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3063 LYNNVILLE CT
Mailing Address - Street 2:
Mailing Address - City:LINDENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:61049-9734
Mailing Address - Country:US
Mailing Address - Phone:815-312-8815
Mailing Address - Fax:
Practice Address - Street 1:417 N COLFAX ST
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:IL
Practice Address - Zip Code:61010-1438
Practice Address - Country:US
Practice Address - Phone:815-234-2722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242007828235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist