Provider Demographics
NPI:1588165336
Name:BECK, KILEY (CF-SLP)
Entity type:Individual
Prefix:
First Name:KILEY
Middle Name:
Last Name:BECK
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3228
Mailing Address - Country:US
Mailing Address - Phone:815-871-0414
Mailing Address - Fax:
Practice Address - Street 1:200 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:IL
Practice Address - Zip Code:61024-9403
Practice Address - Country:US
Practice Address - Phone:815-248-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242004514235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist