Provider Demographics
NPI:1831759570
Name:HANNIGAN JACKSON, SHANNON (LCPC)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:HANNIGAN JACKSON
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 1:3910 THORNBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-4625
Mailing Address - Country:US
Mailing Address - Phone:224-339-3454
Mailing Address - Fax:
Practice Address - Street 1:3910 THORNBERRY WAY
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-4625
Practice Address - Country:US
Practice Address - Phone:224-339-3454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional