Provider Demographics
NPI:1942464698
Name:WHITELOW, SHAE N (BS, CADC)
Entity Type:Individual
Prefix:
First Name:SHAE
Middle Name:N
Last Name:WHITELOW
Suffix:
Gender:F
Credentials:BS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3506
Mailing Address - Country:US
Mailing Address - Phone:618-533-1391
Mailing Address - Fax:618-533-0012
Practice Address - Street 1:101 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3506
Practice Address - Country:US
Practice Address - Phone:618-533-1391
Practice Address - Fax:618-533-0012
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)