Provider Demographics
NPI:1043226848
Name:SHAWGO, JAMIE (LCPC)
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:
Last Name:SHAWGO
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 GASKILL DR.
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62707
Mailing Address - Country:US
Mailing Address - Phone:217-787-7127
Mailing Address - Fax:217-544-8148
Practice Address - Street 1:922 S 4TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2223
Practice Address - Country:US
Practice Address - Phone:217-544-1027
Practice Address - Fax:217-544-8148
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional