Provider Demographics
NPI:1770457558
Name:BEACON PATHWAYS, PLLC
Entity type:Organization
Organization Name:BEACON PATHWAYS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:TRAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:815-997-6654
Mailing Address - Street 1:1643 N ALPINE RD STE 104
Mailing Address - Street 2:PMB515
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1464
Mailing Address - Country:US
Mailing Address - Phone:815-997-6654
Mailing Address - Fax:
Practice Address - Street 1:306 WOLF DEN CIRCLE
Practice Address - Street 2:
Practice Address - City:DAVIS JUNCTION
Practice Address - State:IL
Practice Address - Zip Code:61020
Practice Address - Country:US
Practice Address - Phone:815-997-6654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty