Healthcare Provider Details

I. General information

NPI: 1326780057
Provider Name (Legal Business Name): SHANNON P HART LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 LIONS DR STE 210
BARRINGTON IL
60010-3175
US

IV. Provider business mailing address

987 ASCOT DR
CRYSTAL LAKE IL
60014-8832
US

V. Phone/Fax

Practice location:
  • Phone: 630-428-7890
  • Fax:
Mailing address:
  • Phone: 773-844-3643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149025999
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: