Provider Demographics
NPI:1912335605
Name:SEXTON, SHANA (LCSW)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:SEXTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 LUTHER LN
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1243
Mailing Address - Country:US
Mailing Address - Phone:847-318-2303
Mailing Address - Fax:847-318-2377
Practice Address - Street 1:1610 LUTHER LN
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1243
Practice Address - Country:US
Practice Address - Phone:847-318-2303
Practice Address - Fax:847-318-2377
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0150511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical