Individual
BEVERLY WEST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
116 CLAY ST, GLEN CARBON, IL 62034-1431
(618) 444-6310
(618) 288-3821
Mailing address
116 CLAY ST, GLEN CARBON, IL 62034-1431
(618) 444-6310
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
04/02/2007
Last updated
09/25/2024
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