Provider Demographics
NPI:1518257997
Name:SHIMMEL, SARAH KATHLEEN (LPC)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:KATHLEEN
Last Name:SHIMMEL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 N RACINE AVE
Mailing Address - Street 2:APT. 2E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1525
Mailing Address - Country:US
Mailing Address - Phone:203-273-1815
Mailing Address - Fax:
Practice Address - Street 1:3712 N BROADWAY ST
Practice Address - Street 2:STE. 250
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4235
Practice Address - Country:US
Practice Address - Phone:773-615-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.006717101YP2500X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178.006717OtherLICENSED PROFESSIONAL COUNSELOR