Provider Demographics
NPI:1164897260
Name:QUANDT, SHANNON
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:QUANDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S 4TH ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4187
Mailing Address - Country:US
Mailing Address - Phone:217-347-5880
Mailing Address - Fax:217-347-5897
Practice Address - Street 1:1901 S 4TH ST
Practice Address - Street 2:SUITE 213
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-4187
Practice Address - Country:US
Practice Address - Phone:217-347-5880
Practice Address - Fax:217-347-5897
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005497101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional