Provider Demographics
NPI:1467699827
Name:SONIA SHANKMAN ORTHOGENIC SCHOOL
Entity Type:Organization
Organization Name:SONIA SHANKMAN ORTHOGENIC SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:G
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:773-702-1301
Mailing Address - Street 1:1365 E 60TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-2856
Mailing Address - Country:US
Mailing Address - Phone:773-702-1203
Mailing Address - Fax:773-702-1304
Practice Address - Street 1:1365 E 60TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-2856
Practice Address - Country:US
Practice Address - Phone:773-702-1203
Practice Address - Fax:773-702-1304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5734-613-2320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness