Provider Demographics
NPI:1114106697
Name:SHANKMAN, STEWART AARON (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:AARON
Last Name:SHANKMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 W HARRISON ST RM 1062D
Mailing Address - Street 2:M/C 285
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-7135
Mailing Address - Country:US
Mailing Address - Phone:312-355-3812
Mailing Address - Fax:312-413-4122
Practice Address - Street 1:1007 W HARRISON ST RM 1062D
Practice Address - Street 2:M/C 285
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-7135
Practice Address - Country:US
Practice Address - Phone:312-355-3812
Practice Address - Fax:312-413-4122
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral