Provider Demographics
NPI:1366750549
Name:BEARD-BEAL, ANGELA CHRISTINE (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:CHRISTINE
Last Name:BEARD-BEAL
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 MACKINAW AVE
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5730
Mailing Address - Country:US
Mailing Address - Phone:708-333-7227
Mailing Address - Fax:
Practice Address - Street 1:616 FRANCES ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:IL
Practice Address - Zip Code:60426-2624
Practice Address - Country:US
Practice Address - Phone:708-333-7227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105685235Z00000X
IL146010507235Z00000X
PASL009889235Z00000X
GASLP012485235Z00000X
VA2202010827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist