Basic Information
| Provider Information | |||||||||
| NPI: | 1003005430 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEAUMONT | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11801 SOUTHWEST HIGHWAY | ||||||||
| Address2: | STE 3 SOUTH | ||||||||
| City: | PALOS HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089237400 | ||||||||
| FaxNumber: | 7089237409 | ||||||||
| Practice Location | |||||||||
| Address1: | 11801 SOUTHWEST HIGHWAY | ||||||||
| Address2: | STE 3 SOUTH | ||||||||
| City: | PALOS HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7089237400 | ||||||||
| FaxNumber: | 7089237409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2007 | ||||||||
| LastUpdateDate: | 10/22/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | IL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.