Provider Demographics
NPI:1811245269
Name:CALVERT OSUCHOWSKI, SHANNON LEIGH (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:LEIGH
Last Name:CALVERT OSUCHOWSKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:LEIGH
Other - Last Name:CALVERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:2948 ARTESIAN RD STE 112
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8559
Mailing Address - Country:US
Mailing Address - Phone:630-428-7890
Mailing Address - Fax:
Practice Address - Street 1:2948 ARTESIAN RD STE 112
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8559
Practice Address - Country:US
Practice Address - Phone:630-428-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008716103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071008716OtherILLINOIS DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION