Provider Demographics
NPI:1528624749
Name:BEALE, KATHERINE LEVETTE
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:LEVETTE
Last Name:BEALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21322 KNIGHTBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2963
Mailing Address - Country:US
Mailing Address - Phone:708-856-9937
Mailing Address - Fax:
Practice Address - Street 1:21322 KNIGHTBRIDGE CT
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2963
Practice Address - Country:US
Practice Address - Phone:708-856-9937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist