Provider Demographics
NPI:1730272071
Name:BEAUMONT, DONNA LYNNE
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LYNNE
Last Name:BEAUMONT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-2545
Mailing Address - Country:US
Mailing Address - Phone:618-548-0137
Mailing Address - Fax:
Practice Address - Street 1:1325 W WHITTAKER ST STE C
Practice Address - Street 2:STE C
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-2034
Practice Address - Country:US
Practice Address - Phone:618-548-2181
Practice Address - Fax:618-548-1035
Is Sole Proprietor?:No
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)