Individual
AMANDA YVONNE BEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
306 W MILL ST, CARBONDALE, IL 62901-2727
(618) 529-3060
Mailing address
4355 STATE HIGHWAY 148, MULKEYTOWN, IL 62865-3219
(618) 927-2647
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146.012424
IL
Other
Enumeration date
02/05/2015
Last updated
02/05/2015
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