Provider Demographics
NPI:1801947601
Name:SHINE DUCK, ANN W (LCPC)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:W
Last Name:SHINE DUCK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 HIGHCREST DR
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2358
Mailing Address - Country:US
Mailing Address - Phone:847-251-5789
Mailing Address - Fax:
Practice Address - Street 1:545 LINCOLN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2349
Practice Address - Country:US
Practice Address - Phone:847-757-9077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001295101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04908129OtherBLUE CROSS BLUE SHIELD