Provider Demographics
NPI:1316019573
Name:BEEHLER, CHRISTINE ANNE (SLP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ANNE
Last Name:BEEHLER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 W MONTANA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2409
Mailing Address - Country:US
Mailing Address - Phone:773-935-4755
Mailing Address - Fax:773-935-3699
Practice Address - Street 1:926 W MONTANA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2409
Practice Address - Country:US
Practice Address - Phone:773-935-4755
Practice Address - Fax:773-935-3699
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-0062235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCB22080300POtherEARLY INTERVENTION #
IL01630319OtherBLUE CROSS BLUE SHIELD ID
IL2651305OtherAETNA PROVIDER NUMBER
IL364460695-60614-01Medicaid