Provider Demographics
NPI:1518374180
Name:POE, SHANNON M (LCSW)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:M
Last Name:POE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:M
Other - Last Name:BARR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSW
Mailing Address - Street 1:2654 N CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1102
Mailing Address - Country:US
Mailing Address - Phone:504-952-4762
Mailing Address - Fax:
Practice Address - Street 1:2654 N CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1102
Practice Address - Country:US
Practice Address - Phone:504-952-4762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0259091041C0700X
LA12624104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker