Provider Demographics
NPI:1871605972
Name:BEEM, JACQUELYN (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:BEEM
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N 7TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-6352
Mailing Address - Country:US
Mailing Address - Phone:217-522-9730
Mailing Address - Fax:
Practice Address - Street 1:700 N 7TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-6352
Practice Address - Country:US
Practice Address - Phone:217-522-9730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered