Provider Demographics
NPI:1417723560
Name:JOHNSON-EGGLESTON, SHALON A (MA)
Entity Type:Individual
Prefix:
First Name:SHALON
Middle Name:A
Last Name:JOHNSON-EGGLESTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20280 GOVERNORS HWY
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1028
Mailing Address - Country:US
Mailing Address - Phone:773-364-6620
Mailing Address - Fax:
Practice Address - Street 1:20280 GOVERNORS HWY
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1028
Practice Address - Country:US
Practice Address - Phone:773-364-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling