Provider Demographics
NPI:1558054890
Name:MONTOUT, SHAUNITA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHAUNITA
Middle Name:
Last Name:MONTOUT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9449 S KEDZIE AVE # 570
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2325
Mailing Address - Country:US
Mailing Address - Phone:708-568-1639
Mailing Address - Fax:
Practice Address - Street 1:7601 S OGLESBY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-4120
Practice Address - Country:US
Practice Address - Phone:708-568-1639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490170421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical