Provider Demographics
NPI:1689109837
Name:SHAW, MONIQUE SHANTE (LSW)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:SHANTE
Last Name:SHAW
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 1:1135 LOREN DR
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-2102
Mailing Address - Country:US
Mailing Address - Phone:815-757-3806
Mailing Address - Fax:
Practice Address - Street 1:2487 ALPHA CT W
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-5827
Practice Address - Country:US
Practice Address - Phone:815-757-3806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150106991104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker