Provider Demographics
NPI:1497946867
Name:SHIEL-REARDON, CATHY (MA)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:
Last Name:SHIEL-REARDON
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 1:6220 NORTH PAULINA
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1119
Mailing Address - Country:US
Mailing Address - Phone:773-465-8658
Mailing Address - Fax:
Practice Address - Street 1:6220 NORTH PAULINA
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1119
Practice Address - Country:US
Practice Address - Phone:773-465-8658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490006651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206445Medicare PIN