Provider Demographics
NPI:1720731649
Name:ERDMANN, SHANNON JO (MA, LPC, BA)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:JO
Last Name:ERDMANN
Suffix:
Gender:F
Credentials:MA, LPC, BA
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:JO
Other - Last Name:MORRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:1323 W CHRISTINE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5809
Mailing Address - Country:US
Mailing Address - Phone:309-258-3523
Mailing Address - Fax:
Practice Address - Street 1:4700 N PROSPECT RD STE A2D
Practice Address - Street 2:
Practice Address - City:PEORIA HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:61616-6473
Practice Address - Country:US
Practice Address - Phone:309-258-8851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178017184101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional