Provider Demographics
NPI:1063029874
Name:SHANNON MANNIX SERVICES INC
Entity Type:Organization
Organization Name:SHANNON MANNIX SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER LICENCED SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANNIX
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, TYPE 73
Authorized Official - Phone:708-557-5078
Mailing Address - Street 1:17626 S GILBERT DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-1100
Mailing Address - Country:US
Mailing Address - Phone:708-557-5078
Mailing Address - Fax:
Practice Address - Street 1:15915 S CRYSTAL CREEK DR STE E
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-9381
Practice Address - Country:US
Practice Address - Phone:708-557-5078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty