Provider Demographics
NPI:1629219332
Name:OZINGA, SHANON
Entity Type:Individual
Prefix:
First Name:SHANON
Middle Name:
Last Name:OZINGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16700 ROBINHOOD DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-5749
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 E HURON ST
Practice Address - Street 2:UNIT 1106
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2766
Practice Address - Country:US
Practice Address - Phone:847-997-7157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst