Provider Demographics
NPI:1013681790
Name:SHOOKMAN, ERIK
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:SHOOKMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 N BEACON ST APT 407
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-6253
Mailing Address - Country:US
Mailing Address - Phone:309-251-3444
Mailing Address - Fax:
Practice Address - Street 1:4545 N BEACON ST APT 407
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-6253
Practice Address - Country:US
Practice Address - Phone:309-251-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150105276104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker