MEDICARE: SHAWNA NAZARIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149.028550	IL

General Provider Information

NPI Number	:	1922706514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNA NAZARIAN

Provider Business Mailing Address
First Line	:	4180 S LAKE CT
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-8440
Country	:	US
Telephone Number	:	217-620-2973
Fax Number	:

Provider Business Practice Location Address
First Line	:	5320 W ELM ST
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-4029
Country	:	US
Telephone Number	:	217-620-2973
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2023
Last Update Date	:	03/02/2026

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