1548325749 NPI number — MS. BETH LOUISE PLACHETKA LCSW

Table of content: MS. BETH LOUISE PLACHETKA LCSW (NPI 1548325749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548325749 NPI number — MS. BETH LOUISE PLACHETKA LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLACHETKA
Provider First Name:
BETH
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548325749
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
612 MARIE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORKVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60560-1211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-553-7452
Provider Business Mailing Address Fax Number:
630-553-0077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1121 E MAIN ST
Provider Second Line Business Practice Location Address:
#210
Provider Business Practice Location Address City Name:
ST CHARLES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60174-2275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-272-4959
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)