Provider Demographics
NPI:1790942183
Name:SIMMERING, SHELLEY A (CPED)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:A
Last Name:SIMMERING
Suffix:
Gender:F
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N 2ND ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1804
Mailing Address - Country:US
Mailing Address - Phone:630-740-6331
Mailing Address - Fax:630-587-5537
Practice Address - Street 1:303 N 2ND ST
Practice Address - Street 2:SUITE 10
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1804
Practice Address - Country:US
Practice Address - Phone:630-740-6331
Practice Address - Fax:630-587-5537
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL212-000134174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist