Provider Demographics
NPI:1285862581
Name:THOMAS, SHANNA CLAIR (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:CLAIR
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 N SPARKLE CT
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7942
Mailing Address - Country:US
Mailing Address - Phone:630-913-7045
Mailing Address - Fax:630-551-2213
Practice Address - Street 1:600 SPRING HILL RING RD
Practice Address - Street 2:SUITE 106
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-7300
Practice Address - Country:US
Practice Address - Phone:630-913-7045
Practice Address - Fax:630-551-2213
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0136461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical