Provider Demographics
NPI:1326369760
Name:HAMNING, SHANNON MICHELLE (BCBA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MICHELLE
Last Name:HAMNING
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19060 EVERETT BLVD UNIT 107
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-2500
Mailing Address - Country:US
Mailing Address - Phone:815-641-9187
Mailing Address - Fax:779-324-5236
Practice Address - Street 1:19060 EVERETT BLVD UNIT 107
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-2500
Practice Address - Country:US
Practice Address - Phone:815-641-9187
Practice Address - Fax:779-324-5236
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILH55279387845103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst