Provider Demographics
NPI:1295389948
Name:SHIERK-BOOTH, ALICE (LCPC)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:SHIERK-BOOTH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2463 HIGHMOOR RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-1705
Mailing Address - Country:US
Mailing Address - Phone:847-450-6974
Mailing Address - Fax:
Practice Address - Street 1:2463 HIGHMOOR RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-1705
Practice Address - Country:US
Practice Address - Phone:847-450-6974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.015203101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional