Provider Demographics
NPI:1336687318
Name:GIOVINGO, SHANNON (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:GIOVINGO
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4745 MAIN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1754
Mailing Address - Country:US
Mailing Address - Phone:630-442-1895
Mailing Address - Fax:
Practice Address - Street 1:4745 MAIN STREET
Practice Address - Street 2:SUITE 207
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1758
Practice Address - Country:US
Practice Address - Phone:630-442-1895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150011404104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker