Provider Demographics
NPI:1346387495
Name:WESLEY, SHAE MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:SHAE
Middle Name:MICHELLE
Last Name:WESLEY
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 1:9 CURRENCY DR
Mailing Address - Street 2:#308
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-9481
Mailing Address - Country:US
Mailing Address - Phone:309-318-0697
Mailing Address - Fax:
Practice Address - Street 1:1150 ROUTE 54 WEST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727
Practice Address - Country:US
Practice Address - Phone:217-935-2218
Practice Address - Fax:217-935-2788
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator