Provider Demographics
NPI:1215455852
Name:BANKS, BETHANY (LISCENED COSMETOLOGI)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:LISCENED COSMETOLOGI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9161 W. CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RIVERIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546
Mailing Address - Country:US
Mailing Address - Phone:708-853-9230
Mailing Address - Fax:
Practice Address - Street 1:9161 W. CERMAK RD
Practice Address - Street 2:
Practice Address - City:NORTH RIVERIDE
Practice Address - State:IL
Practice Address - Zip Code:60546
Practice Address - Country:US
Practice Address - Phone:708-853-9230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL012.007533224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist