Provider Demographics
NPI:1063665008
Name:ALDRIDGE, SHANNON N (LSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:N
Last Name:ALDRIDGE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 OAKFIELD CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60503-4779
Mailing Address - Country:US
Mailing Address - Phone:630-820-9263
Mailing Address - Fax:
Practice Address - Street 1:1289 WINDHAM PKWY
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-1763
Practice Address - Country:US
Practice Address - Phone:630-759-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150010426104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker