Provider Demographics
NPI:1851752018
Name:SHEENA, ENANNA (MS)
Entity Type:Individual
Prefix:
First Name:ENANNA
Middle Name:
Last Name:SHEENA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 W LUNT AVE
Mailing Address - Street 2:UNIT 204
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-3532
Mailing Address - Country:US
Mailing Address - Phone:773-759-3862
Mailing Address - Fax:
Practice Address - Street 1:73 W MONROE ST STE 227
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-4910
Practice Address - Country:US
Practice Address - Phone:773-759-3862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242003881235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL242003881OtherIDFPR LICENSE NUMBER