Provider Demographics
NPI:1952836454
Name:KELLEY-SWANSON, SHAWNA (NCC, LPC)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:KELLEY-SWANSON
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 RIESER CIR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2033
Mailing Address - Country:US
Mailing Address - Phone:630-983-0699
Mailing Address - Fax:
Practice Address - Street 1:1607 N AURORA RD
Practice Address - Street 2:SUITE 204
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2784
Practice Address - Country:US
Practice Address - Phone:630-772-9209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-22
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178009678101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health