Provider Demographics
NPI:1629671458
Name:MCCOY, SHIANNE LORAN (LSW)
Entity Type:Individual
Prefix:
First Name:SHIANNE
Middle Name:LORAN
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7371 N WINCHESTER AVE APT 1E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-5506
Mailing Address - Country:US
Mailing Address - Phone:312-662-9971
Mailing Address - Fax:
Practice Address - Street 1:331 W SURF ST STE 809
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-7227
Practice Address - Country:US
Practice Address - Phone:773-800-7280
Practice Address - Fax:877-428-7891
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X.1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical