Provider Demographics
NPI:1700405594
Name:FREEMAN, SHAUNE DOUGLAS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SHAUNE
Middle Name:DOUGLAS
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14741 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-1527
Mailing Address - Country:US
Mailing Address - Phone:708-310-9226
Mailing Address - Fax:
Practice Address - Street 1:14741 CLARK ST
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-1527
Practice Address - Country:US
Practice Address - Phone:708-310-9226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-11
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0150501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty