Provider Demographics
NPI:1093008203
Name:WHITEHEAD, SHANTELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHANTELLE
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2742 BORKSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-4419
Mailing Address - Country:US
Mailing Address - Phone:312-339-9832
Mailing Address - Fax:630-857-9101
Practice Address - Street 1:552 S WASHINGTON ST STE 115
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6669
Practice Address - Country:US
Practice Address - Phone:312-339-9832
Practice Address - Fax:630-857-9101
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008050103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical