Provider Demographics
NPI:1720521677
Name:SHEEHAN, KATHERINE (LSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 PLUM ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4315
Mailing Address - Country:US
Mailing Address - Phone:630-730-3816
Mailing Address - Fax:
Practice Address - Street 1:66 MILLER DR
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-5143
Practice Address - Country:US
Practice Address - Phone:630-570-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-27
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.103673104100000X
ILRBT-16-22093106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician