Provider Demographics
NPI:1528881133
Name:BEATHEA, TOYANNA A (MSW, LSW)
Entity type:Individual
Prefix:
First Name:TOYANNA
Middle Name:A
Last Name:BEATHEA
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1084 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-3472
Mailing Address - Country:US
Mailing Address - Phone:309-351-2697
Mailing Address - Fax:
Practice Address - Street 1:1586 37TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7213
Practice Address - Country:US
Practice Address - Phone:309-944-7833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150113832104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker