Provider Demographics
NPI:1760892186
Name:WORD, SHANNON (NCC, LCPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:WORD
Suffix:
Gender:F
Credentials:NCC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 LINCOLN HWY STE 106
Mailing Address - Street 2:SUITE 106
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1862
Mailing Address - Country:US
Mailing Address - Phone:708-910-4579
Mailing Address - Fax:708-898-0968
Practice Address - Street 1:2601 LINCOLN HWY
Practice Address - Street 2:STE 106
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1862
Practice Address - Country:US
Practice Address - Phone:708-910-4579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006388101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional