Provider Demographics
NPI:1457159816
Name:BEAVER, CAITLIN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:BEAVER
Suffix:
Gender:
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WINDAMERE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:IL
Mailing Address - Zip Code:62684-9561
Mailing Address - Country:US
Mailing Address - Phone:217-741-5266
Mailing Address - Fax:
Practice Address - Street 1:401 WINDAMERE
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:IL
Practice Address - Zip Code:62684-9561
Practice Address - Country:US
Practice Address - Phone:217-741-5266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146017951235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist