Provider Demographics
NPI:1316910581
Name:BEARDSLEY, JEANNE (MSW)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:
Last Name:BEARDSLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12868 215TH AVE
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:IA
Mailing Address - Zip Code:50262-5013
Mailing Address - Country:US
Mailing Address - Phone:641-445-5529
Mailing Address - Fax:
Practice Address - Street 1:12868 215TH AVE
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:IA
Practice Address - Zip Code:50262-5013
Practice Address - Country:US
Practice Address - Phone:641-445-5529
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA38772Medicare UPIN