Provider Demographics
NPI:1013076702
Name:LARGENT, BECKY (LCSW, APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:LARGENT
Suffix:
Gender:F
Credentials:LCSW, APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 FOX RUN
Mailing Address - Street 2:
Mailing Address - City:DOWNS
Mailing Address - State:IL
Mailing Address - Zip Code:61736-9324
Mailing Address - Country:US
Mailing Address - Phone:309-825-6648
Mailing Address - Fax:
Practice Address - Street 1:205 N WILLIAMSBURG DR STE A
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-7721
Practice Address - Country:US
Practice Address - Phone:309-433-0113
Practice Address - Fax:309-777-6077
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277003385363LP0808X
IL209.021596363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health